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Santiago-Santiago AJ, Rivera-Custodio J, Mercado-Ríos CA, González-Font Y, R Madera S, Varas-Díaz N, Padilla M, Ramos-Pibernus A, Rivera-Bustelo K, Vertovec J, Matiz-Reyes A, Grove K. Puerto Rican physician's recommendations to mitigate medical migration from Puerto Rico to the mainland United States. HEALTH POLICY OPEN 2024; 7:100124. [PMID: 39099675 PMCID: PMC11296234 DOI: 10.1016/j.hpopen.2024.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/23/2024] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
Puerto Rico (PR) is a United States (US) territory with a history of colonial violence, poverty, and government corruption. Due to these sociopolitical factors and natural disasters (e.g., hurricanes and earthquakes), there has been a sharp increase in PR residents migrating to the mainland US. Local media and professional health organizations focus on the impact of medical migration on the PR health system (e.g., health personnel shortages and long waiting periods for critical care). According to the PR College of Physicians and Surgeons, 365-500 physicians have left annually since 2014, which represents a crisis of access to health services. However, few studies have focused on ways to mitigate medical migration from PR to the US mainland. This article describes the recommendations provided by migrating and non-migrating Puerto Rican Physicians (PRPs) to mitigate medical migration from PR to the US mainland. We focus on qualitative data from a mixed-methods NIH-funded study (1R01MD014188) to explore factors that motivate or mitigate migration among migrating (n = 26) and non-migrating (n = 24) PRPs. Interviews were analyzed following thematic analysis guidelines. Results show the following themes: 1) strategies to retain early-career medical residents living in PR; 2) recommendations for local government on future health policy; and 3) work environment initiatives for health institutions to mitigate physician migration. Findings suggest multilevel efforts are required to mitigate medical migration in PR.
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Affiliation(s)
| | | | | | | | | | | | - Mark Padilla
- Florida International University, Florida, United States
| | | | | | - John Vertovec
- Florida International University, Florida, United States
| | | | - Kevin Grove
- Florida International University, Florida, United States
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2
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Mansfield BS, Mohamed F, Larouche M, Raal FJ. The Hurdle of Access to Emerging Therapies and Potential Solutions in the Management of Dyslipidemias. J Clin Med 2024; 13:4160. [PMID: 39064199 PMCID: PMC11277596 DOI: 10.3390/jcm13144160] [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: 06/12/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
This review explores the many barriers to accessing lipid-lowering therapies (LLTs) for the prevention and management of atherosclerotic cardiovascular disease (ASCVD). Geographical, knowledge, and regulatory barriers significantly impede access to LLTs, exacerbating disparities in healthcare infrastructure and affordability. We highlight the importance of policy reforms, including pricing regulations and reimbursement policies, for enhancing affordability and streamlining regulatory processes. Innovative funding models, such as value-based pricing and outcome-based payment arrangements, have been recommended to make novel LLTs more accessible. Public health interventions, including community-based programs and telemedicine, can be utilized to reach underserved populations and improve medication adherence. Education and advocacy initiatives led by patient advocacy groups and healthcare providers play a crucial role in raising awareness and empowering patients. Despite the barriers to access, novel LLTs present a big opportunity to reduce the burden of ASCVD, emphasizing the need for collaborative efforts among policymakers, healthcare providers, industry stakeholders, and patient advocacy groups to address these barriers to improve access to LLTs globally.
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Affiliation(s)
- Brett S. Mansfield
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Farzahna Mohamed
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Miriam Larouche
- Département de Médecine, Université de Montréal and ECOGENE-21, Montreal, QC H3T 1J4, Canada;
| | - Frederick J. Raal
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
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Rubin MA, Lewis A, Creutzfeldt CJ, Shrestha GS, Boyle Q, Illes J, Jox RJ, Trevick S, Young MJ. Equity in Clinical Care and Research Involving Persons with Disorders of Consciousness. Neurocrit Care 2024:10.1007/s12028-024-02012-3. [PMID: 38872033 DOI: 10.1007/s12028-024-02012-3] [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: 03/22/2024] [Accepted: 05/09/2024] [Indexed: 06/15/2024]
Abstract
People with disorders of consciousness (DoC) are characteristically unable to synchronously participate in decision-making about clinical care or research. The inability to self-advocate exacerbates preexisting socioeconomic and geographic disparities, which include the wide variability observed across individuals, hospitals, and countries in access to acute care, expertise, and sophisticated diagnostic, prognostic, and therapeutic interventions. Concerns about equity for people with DoC are particularly notable when they lack a surrogate decision-maker (legally referred to as "unrepresented" or "unbefriended"). Decisions about both short-term and long-term life-sustaining treatment typically rely on neuroprognostication and individual patient preferences that carry additional ethical considerations for people with DoC, as even individuals with well thought out advance directives cannot anticipate every possible situation to guide such decisions. Further challenges exist with the inclusion of people with DoC in research because consent must be completed (in most circumstances) through a surrogate, which excludes those who are unrepresented and may discourage investigators from exploring questions related to this population. In this article, the Curing Coma Campaign Ethics Working Group reviews equity considerations in clinical care and research involving persons with DoC in the following domains: (1) access to acute care and expertise, (2) access to diagnostics and therapeutics, (3) neuroprognostication, (4) medical decision-making for unrepresented people, (5) end-of-life decision-making, (6) access to postacute rehabilitative care, (7) access to research, (8) inclusion of unrepresented people in research, and (9) remuneration and reciprocity for research participation. The goal of this discussion is to advance equitable, harmonized, guideline-directed, and goal-concordant care for people with DoC of all backgrounds worldwide, prioritizing the ethical standards of respect for autonomy, beneficence, and justice. Although the focus of this evaluation is on people with DoC, much of the discussion can be extrapolated to other critically ill persons worldwide.
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Affiliation(s)
- Michael A Rubin
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | - Claire J Creutzfeldt
- Harborview Medical Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence, Seattle, WA, USA
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Quinn Boyle
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ralf J Jox
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Michael J Young
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Neurocritical Care, Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, USA.
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O Abah G, O Okafor S, Anyoko-Shaba O, Nnamchi OC, Ọkop EO, Ogunleye A. Factors to Effective Clinical Experience, Willingness to pursue Career in Rural Health Facilities among Nursing Students on Clinical Placement in Southeast Nigeria and Rural Development. INVESTIGACION Y EDUCACION EN ENFERMERIA 2024; 42:e09. [PMID: 39083836 PMCID: PMC11297459 DOI: 10.17533/udea.iee.v42n2e09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 05/14/2024] [Indexed: 08/02/2024]
Abstract
Objective To describe the Factors to Effective Clinical Experience and Willingness to pursue Career in Rural Health Facilities among Nursing Students on Clinical Placement in southeast Nigeria. Methods The study was conducted among 48 rural health centres and general hospitals with 528 respondents from different higher institutions of learning serving in these health facilities for their clinical experience. The study applied survey design and utilized questionnaire instrument for data collection. Results Majority of the students (60%) agreed that their school lacked functional practical demonstration laboratory for students' clinical practice, 66.7% agreed that their school lab lacked large space for all the students to observe what is being taught, 79.9% that their school lab lacked enough equipment that can enable many students to practice procedures; majority of the students (79.9%) answered that the hospitals where they are on clinical placement lacked enough equipment needed for the students on each shift of practice, 59.9% agreed that student/client ratio in each ward during clinical experience periods was not enough for students' practice under supervision, while 73.3% indicated that their school lacked library with current nursing texts for references. Personal, socioeconomic and institutional factors explain the 76% of the variance of effective clinical experience and the 52% of the variance of the willingness to work in rural health facilities in the future if offered employment. Conclusion The factors surrounding effective clinical experience in rural healthcare facilities in southeastern Nigeria are unfavorable and could discourage future nurses from working there. It is necessary to implement strategies to improve the management of these centers in order to promote the perspective of improving sustainable rural health in this region.
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Affiliation(s)
- George O Abah
- Senior Lecturer. Philosophy Department, University of Nigeria, Nsukka.
| | - Samuel O Okafor
- Ph.D. student and research consultant. Department of Sociology/Anthropology, University of Nigeria, Nsukka.
| | | | | | - Ekaette O Ọkop
- Lecturer. Department of Adult Education and extra Moral Studies, University of Nigeria, Nsukka.
| | - Akindele Ogunleye
- Consultant. EI Paso Educational Leadership and Foundations, University of Texas, USA.
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Ebbs D, Taricia M, Funaro MC, O’Daniel M, Cappello M. Prehospital use of point-of-care tests by community health workers: a scoping review. Front Public Health 2024; 12:1360322. [PMID: 38721545 PMCID: PMC11076783 DOI: 10.3389/fpubh.2024.1360322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/06/2024] [Indexed: 05/15/2024] Open
Abstract
Introduction Point-of-Care Tests (POCTs) are utilized daily in resource abundant regions, however, are limited in the global south, particularly in the prehospital setting. Few studies exist on the use of non-malarial POCTs by Community Health Workers (CHWs). The purpose of this scoping review is to delineate the current diversity in and breadth of POCTs evaluated in the prehospital setting. Methods A medical subject heading (MeSH) analysis of known key articles was done by an experienced medical librarian and scoping searches were performed in each database to capture "point of care testing" and "community health workers." This review was guided by the PRISMA Extension for scoping reviews. Results 2735 publications were returned, 185 were nominated for full-text review, and 110 studies were confirmed to meet study criteria. Majority focused on malaria (74/110; 67%) or HIV (25/110; 23%); 9/110 (8%) described other tests administered. Results from this review demonstrate a broad geographic range with significant heterogeneity in terminology for local CHWs. Conclusion The use of new POCTs is on the rise and may improve early risk stratification in limited resource settings. Current evidence from decades of malaria POCTs can guide future implementation strategies.
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Affiliation(s)
- Daniel Ebbs
- Department of Pediatrics, Yale University, New Haven, CT, United States
| | - Max Taricia
- Department of Pediatrics, Yale University, New Haven, CT, United States
| | - Melissa C. Funaro
- Department of Medicine, Harvey Cushing/John Hay Whitney Medical Library, New Haven, CT, United States
| | - Maggie O’Daniel
- University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Michael Cappello
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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Pooe A, Ntuli ST, Masango S, Rab A, Mudau T, Moloko P, Mtshali S. Specialties preference by gender among medical students at Sefako Makgatho Health Sciences University, South Africa. S Afr Fam Pract (2004) 2024; 66:e1-e6. [PMID: 38708748 PMCID: PMC11079371 DOI: 10.4102/safp.v66i1.5858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND To determine the speciality preferences and the gender differences in the choice of speciality among medical students at Sefako Makgatho Health Sciences University, South Africa. METHODS This cross-sectional study was conducted among fourth- to sixth-year medical students. A structured self-administered questionnaire was used to collect the data. Data analysis was performed using STATA version 16 (StataCorp, College Station, TX, United States). RESULTS A total of 174 students participated (response rate of 74%). Their median age was 23 years with interquartile range of 2 years. More than half (57%) were females. About 83% had no previous qualifications. Most (89%) have shown interest in pursuing specialist training. Surgery, obstetrics and gynaecology and internal medicine were the most selected specialities, while family medicine, ophthalmology, forensic medicine, public health medicine, ear, nose and throat, and accident and emergency medicine were the least preferred. Males were more likely interested in surgery and internal medicine, while females preferred obstetrics and gynaecology. CONCLUSION The majority of the medical students intends to pursue their postgraduate medical training. Even though the results were not statistically significant, there are gender differences in speciality preferences. There is a need to develop and implement career guidance and recruitment plans to deal with specialities with poor recruitment and gender imbalance.Contribution: To deal with specialties with poor and gender imbalance, career guidance and recruitment plans must be developed and implemented.
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Affiliation(s)
- Andiswa Pooe
- Department of Haematological Pathology, Faculty of Medicine, Sefako Makgatho Health Sciences, Pretoria.
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Lee ACK, Morling JR. The looming global workforce crisis in primary care. Public Health 2024; 229:63-64. [PMID: 38402664 DOI: 10.1016/j.puhe.2023.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
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Shrestha GS, Nepal G, Prust ML. Developing Systems of Emergency and Inpatient Neurologic Care in Resource-Limited Settings. Semin Neurol 2024; 44:105-118. [PMID: 38485125 DOI: 10.1055/s-0043-1778638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Neurologic diseases represent a significant global health challenge, leading to disability and mortality worldwide. Healthcare systems in low- and middle-income countries are disproportionally affected. In these resource-limited settings, numerous barriers hinder the effective delivery of emergency and inpatient neurologic care, including shortages of trained personnel, limited access to diagnostics and essential medications, inadequate facilities, and absence of rehabilitation services. Disparities in the neurology workforce, limited access to neuroimaging, and availability of acute interventions further exacerbate the problem. This article explores strategies to enhance global capacity for inpatient neurologic care, emphasizing the importance of workforce development, context-specific protocols, telehealth solutions, advocacy efforts, and collaborations.
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Affiliation(s)
- Gentle Sunder Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Gaurav Nepal
- Department of General Medicine, Rani Primary Healthcare Centre, Rani, Biratnagar, Nepal
| | - Morgan Lippitt Prust
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut
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Merz S, Hunter BM, Murray SF, Bisht R. Market making and the production of nurses for export: a case study of India-UK health worker migration. BMJ Glob Health 2024; 9:e014096. [PMID: 38418245 PMCID: PMC10910680 DOI: 10.1136/bmjgh-2023-014096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/06/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND High-income countries increasingly look to the international recruitment of health workers to address domestic shortages, especially from low-income and middle-income countries. We adapt conceptual frameworks from migration studies to examine the networked and commercialised nature of the Indian market for nurse migration to the UK. METHODS We draw on data from 27 expert interviews conducted with migration intermediaries, healthcare providers and policymakers in India and the UK. FINDINGS India-UK nurse migration occurs within a complex and evolving market encompassing ways to educate, train and recruit nursing candidates. For-profit actors shape the international orientation of nursing curricula, broker on-the-job training and offer language, exam and specialised clinical training. Rather than merely facilitate travel, these brokers produce both generic, emigratory nurses as well as more customised nurses ready to meet specific shortages in the UK. DISCUSSION The dialectic of producing emigratory and customised nurses is similar to that seen in the Post-Fordist manufacturing model characterised by flexible specialisation and a networked structure. As the commodity in this case are people attempting to improve their position in life, these markets require attention from health policy makers. Nurse production regimes based on international market opportunities are liable to change, subjecting nurses to the risk of having trained for a market that can no longer accommodate them. The commercial nature of activities further entrenches existing socioeconomic inequalities in the Indian nurse force. Negative repercussions for the source healthcare system can be anticipated as highly qualified, specialised nurses leave to work in healthcare systems abroad.
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Affiliation(s)
- Sibille Merz
- Department of International Development, King's College London, London, UK
| | - Benjamin M Hunter
- School of Social & Political Sciences, University of Glasgow, Glasgow, UK
- School of Global Studies, University of Sussex, Brighton, UK
| | - Susan F Murray
- Department of International Development, King's College London, London, UK
| | - Ramila Bisht
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
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Zadey S, Rao S, Gondi I, Sheneman N, Patil C, Nayan A, Iyer H, Kumar AR, Prasad A, Finley GA, Prasad CRK, Chintamani, Sharma D, Ghosh D, Jesudian G, Fatima I, Pattisapu J, Ko JS, Bains L, Shah M, Alam MS, Hadigal N, Malhotra N, Wijesuriya N, Shukla P, Khan S, Pandya S, Khan T, Tenzin T, Hadiga VR, Peterson D. Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia. Front Public Health 2024; 12:1325922. [PMID: 38450144 PMCID: PMC10915281 DOI: 10.3389/fpubh.2024.1325922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- GEMINI Research Center, Duke University School of Medicine, Durham, NC, United States
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
| | - Shirish Rao
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Isha Gondi
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Health and Human Sciences, Baylor University, Waco, TX, United States
| | - Natalie Sheneman
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
| | - Chaitrali Patil
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Biology and Statistics, George Washington University, Washington, DC, United States
| | - Anveshi Nayan
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Arti Raj Kumar
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Arun Prasad
- Indraprastha Apollo Hospital, New Delhi, India
| | - G. Allen Finley
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | | | - Chintamani
- Department of Surgery, Vardhman Mahavir Medical College Safdarjung Hospital, New Delhi, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Dhruva Ghosh
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Gnanaraj Jesudian
- Karunya Rural Community Hospital Karunya Nagar, Coimbatore, Tamil Nadu, India
- Association of Rural Surgeons of India, Wardha, India
- International Federation of Rural Surgeons, Ujjain, India
- Rural Surgery Innovations Private Limited, Dimapur, Nagaland, India
| | - Irum Fatima
- IRD Pakistan and the Global Surgery Foundation, Karachi, Sindh, Pakistan
| | - Jogi Pattisapu
- University of Central Florida College of Medicine, Orlando, FL, United States
| | - Justin Sangwook Ko
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, Maharashtra, India
| | - Mashal Shah
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammed Shadrul Alam
- Department of Pediatric Surgery, Mugda Medical College, Dhaka, Bangladesh
- American College of Surgeons: Bangladesh Chapter, Dhaka, Bangladesh
- Bangladesh Health Economist Forum, Dhaka, Bangladesh
- Association of Pediatric Surgeons of Bangladesh (APSB), DMCH, Dhaka, Bangladesh
| | - Narmada Hadigal
- Narmada Fertility Centre, Hyderabad, Telangana, India
- International Trauma Anesthesia and Critical Care Society, Stavander, Stavanger, Norway
| | - Naveen Malhotra
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nilmini Wijesuriya
- College of Anaesthesiologists and Intensivists of Sri Lanka, Rajagiriya, Sri Lanka
| | - Prateek Shukla
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sunil Pandya
- Department of Anaesthesia, Perioperative Medicine and Critical Care, AIG Hospitals, Hyderabad, Telangana, India
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tashi Tenzin
- Army Medical Services, Military Hospital, Thimphu, Bhutan
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Daniel Peterson
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
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Jinah N, Abdullah Sharin I, Bakit P, Adnan IK, Lee KY. Overview of Retention Strategies for Medical Doctors in Low- and Middle-Income Countries and Their Effectiveness: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e52938. [PMID: 38190235 PMCID: PMC10804252 DOI: 10.2196/52938] [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: 09/21/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The global shortage and maldistribution of health care workers, especially medical doctors, pose a significant threat to achieving the United Nations' sustainable development goal 3 of ensuring well-being and healthy lives for all. Low- and middle-income countries (LMICs) are disproportionately affected by this crisis, with a high rate of brain drain from rural to urban areas, as well as to high-income countries. Various retention strategies have been implemented in different settings and organizations. However, their effectiveness remains underexplored, particularly in LMICs. OBJECTIVE We aim to review the available retention strategies for medical doctors in LMICs and to determine the effectiveness of the various strategies. This review aims to compile relevant research findings on this issue to generate a thorough summary of all the retention strategies practiced in LMICs and, more importantly, to provide the current state of evidence of the effectiveness of these strategies in retaining medical doctors in countries with limited resources and high disease burden. METHODS The structured framework given by Arksey and O'Malley will serve as the basis for conducting this scoping review. A comprehensive search strategy will be conducted across 4 electronic databases (PubMed, EBSCOHost, Scopus, and ScienceDirect). A systematic approach following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be executed to search, screen, review, and extract data from studies that meet predefined inclusion criteria. Data encompassing bibliographical information, study location, retention strategies, influencing factors, and outcomes (effectiveness) will be obtained from the selected studies using standardized data extraction. Endnote and Microsoft Excel will be used for reference management and removal of duplicate studies. A narrative synthesis will be performed after categorizing and analyzing all the extracted data to identify recurrent themes. RESULTS This ongoing review will generate a comprehensive compilation of retention strategies implemented in LMICs to prevent brain drain among medical doctors. Data extraction is currently in progress, and completion is expected by early 2024. Themes regarding the types of strategies, influencing factors, and outcomes will be synthesized. The findings will highlight effective retention strategies, gaps, and challenges in implementation for the benefits of future research. By identifying common barriers and facilitators, this review will provide insights into enhancing the policies and initiatives for doctor retention in LMICs. CONCLUSIONS This scoping review explores the retention strategies practiced in LMICs and attempts to identify effective strategies from existing research. By evaluating the barriers and challenges that influence the effectiveness of these strategies, policymakers and health care leaders can strive to obtain balanced and optimal health human resources in their respective organizations and countries. TRIAL REGISTRATION Malaysian National Medical Research Register (NMRR) ID-23-01994-OGW; https://nmrr.gov.my/research-directory/ac4f5b88-8619-4b2b-b6c7-9abcef65fdcd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52938.
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Affiliation(s)
- Norehan Jinah
- Centre of Leadership & Professional Development, Institute for Health Management, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | - Ili Abdullah Sharin
- Centre of Leadership & Professional Development, Institute for Health Management, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | - Pangie Bakit
- Centre of Leadership & Professional Development, Institute for Health Management, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | - Izzuan Khirman Adnan
- Centre of Leadership & Professional Development, Institute for Health Management, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | - Kun Yun Lee
- Centre of Leadership & Professional Development, Institute for Health Management, National Institutes of Health Malaysia, Shah Alam, Malaysia
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12
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Eaton J, Baingana F, Abdulaziz M, Obindo T, Skuse D, Jenkins R. The negative impact of global health worker migration, and how it can be addressed. Public Health 2023; 225:254-257. [PMID: 37949017 DOI: 10.1016/j.puhe.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/07/2023] [Accepted: 09/15/2023] [Indexed: 11/12/2023]
Abstract
International migration of healthcare workers is well established and has become a means of maintaining service quality in many high income countries. In recent years, there has been a dramatic increase in recruitment of health personnel who have been trained abroad, including from the poorest countries in the world. In this article, using General Medical Council (GMC) data, we chart the growth in numbers of international staff working in the United Kingdom, where since 2018, over half of all new GMC registrations have been of doctors trained abroad. There is evidence that this migration of health staff results in poorer health service provision in low and middle income countries, as well as substantial economic impacts in these countries that have invested in training their health workforce. Recruiting governments have argued that remittances compensate for the loss of personnel, and that training opportunities can enable skills transfer to countries with weaker health systems. However, we found that the costs to the source countries dwarfed remittances, and that only a tiny fraction of people who move to take up posts in wealthier countries ever return to their countries of origin to work. We conclude that in addition to the investment in health systems (and workforce development) in low and middle income countries as part of Official Development Assistance for Health, there is an urgent need to increase training of nurses and doctors so that damaging migration is no longer relied upon to fill gaps in healthcare personnel.
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Affiliation(s)
- J Eaton
- London School of Hygiene and Tropical Medicine, UK.
| | - F Baingana
- World Health Organization, African Regional Office, People's Republic of Congo
| | - M Abdulaziz
- Africa Centres for Disease Control and Prevention, Ethiopia
| | - T Obindo
- Association of Psychiatrists in Nigeria and University of Jos, Nigeria
| | - D Skuse
- University College London, UK
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13
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Wang X, Sanders HM, Liu Y, Seang K, Tran BX, Atanasov AG, Qiu Y, Tang S, Car J, Wang YX, Wong TY, Tham YC, Chung KC. ChatGPT: promise and challenges for deployment in low- and middle-income countries. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 41:100905. [PMID: 37731897 PMCID: PMC10507635 DOI: 10.1016/j.lanwpc.2023.100905] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/14/2023] [Accepted: 09/03/2023] [Indexed: 09/22/2023]
Abstract
In low- and middle-income countries (LMICs), the fields of medicine and public health grapple with numerous challenges that continue to hinder patients' access to healthcare services. ChatGPT, a publicly accessible chatbot, has emerged as a potential tool in aiding public health efforts in LMICs. This viewpoint details the potential benefits of employing ChatGPT in LMICs to improve medicine and public health encompassing a broad spectrum of domains ranging from health literacy, screening, triaging, remote healthcare support, mental health support, multilingual capabilities, healthcare communication and documentation, medical training and education, and support for healthcare professionals. Additionally, we also share potential concerns and limitations associated with the use of ChatGPT and provide a balanced discussion on the opportunities and challenges of using ChatGPT in LMICs.
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Affiliation(s)
- Xiaofei Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Hayley M. Sanders
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yuchen Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Kennarey Seang
- Grant Management Office, University of Health Sciences, Phnom Penh, Cambodia
| | - Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Institute of Health Economics and Technology, Hanoi, Vietnam
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, 05-552, Magdalenka, Poland
| | - Yue Qiu
- Institute for Hospital Management, Tsinghua University, Beijing, China
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
- School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Centre for Innovation and Precision Eye Health, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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14
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Gaba F, Ash K, Blyuss O, Bizzarri N, Kamfwa P, Saiz A, Cibula D. International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1). Cancers (Basel) 2023; 15:5001. [PMID: 37894368 PMCID: PMC10605858 DOI: 10.3390/cancers15205001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between HIC and LMIC settings. Study design consisted of a multicentre, international prospective cohort study of women undergoing surgery for gynaecological malignancies (NCT04579861). Multilevel logistic regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820 patients from 73 hospitals in 27 countries. Minor morbidity (Clavien-Dindo I-II) was 26.5% (178/672) and 26.5% (267/1009), whilst major morbidity (Clavien-Dindo III-V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Higher minor morbidity was associated with pre-operative mechanical bowel preparation (OR = 1.474, 95%CI = 1.054-2.061, p = 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066-1.472, p = 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081-1.502, p = 0.004). Higher major morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128-1.664, p = 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175-1.664, p ≤ 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major complication (OR = 2.982, 95%CI = 1.509-5.894, p = 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. We conclude that LMICs and HICs were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention.
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Affiliation(s)
- Faiza Gaba
- Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Karen Ash
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, UK
| | - Oleg Blyuss
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Paul Kamfwa
- Cancer Diseases Hospital, Lusaka 10101, Zambia
| | - Allison Saiz
- Northwestern University in Chicago, Chicago, IL 60611, USA
| | - David Cibula
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, 121 08 Prague, Czech Republic
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15
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Mabunda SA, Durbach A, Chitha WW, Phiri H, Phalane M, Moaletsane O, Angell B, Joshi R. Effectiveness of return-of-service schemes for human resources for health retention: a retrospective cohort study of four Southern African countries. BMJ Glob Health 2023; 8:e013687. [PMID: 37879653 PMCID: PMC10603424 DOI: 10.1136/bmjgh-2023-013687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/07/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Governments use return-of-service (RoS) schemes to train, employ and retain health professionals in the public sector. We determined the effectiveness of RoS schemes in four Southern African countries. METHODS This retrospective cohort study used databases of RoS beneficiaries from South Africa, Botswana, Eswatini and Lesotho. We ascertained the period of funding for beneficiaries between 2000 and 2010, study programme, selection criteria, study country and if they completed their studies. Records were sought to track beneficiaries' service and fulfilment of their RoS obligations. Data were sought at the provincial level in South Africa and nationally for the other three countries. Binomial logistics regression and Kaplan-Meier survival estimates were used to determine risk factors and predictors of defaulting. RESULTS Most beneficiary enrolment (eg, decision on why they were funded, socioeconomic status, disability status, high school results) and service data (eg, health facilities where they worked, how long they worked at each health facility, movement between health facilities) were not available. A total of 5616 beneficiaries were drawn from the four countries' databases. Of those with full data available, 21.7% (229/1056) were retained/served beyond their obligatory period and 20.2% (213/1056) were still serving. A total of 24.3% (95% CI: 21.7% to 26.9%; n=257/1056) of beneficiaries in the final subanalysis of two South African provinces fulfilled their contractual obligations. Only 32.2% (277/861) of beneficiaries undertook internship within their funding provinces. Governments needed to fund six beneficiaries to have one beneficiary complete their contractual obligation if they undertook internship outside their province. CONCLUSION Record keeping in all countries was poor, hampering the effectiveness of RoS schemes. Of the units with full data available, the retention rate was below 25%, and internship being undertaken outside the funding province was associated with higher defaulter rates, calling for a policy overhaul.
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Affiliation(s)
- Sikhumbuzo A Mabunda
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- George institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrea Durbach
- Australian Human Rights Institute, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Wezile W Chitha
- Health Systems Enablement and Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
- Public Health, Walter Sisulu University, Mthatha, South Africa
| | - Hawor Phiri
- Mpumalanga Department of Health, Mbombela, South Africa
| | | | - Oduetse Moaletsane
- Pharmacovigilance and Clinical Trials, Botswana Medicines Regulatory Authority, Gaborone, Botswana
| | - Blake Angell
- George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Rohina Joshi
- School of Population Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia
- George Institute for Global Health, Delhi, India
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16
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Chidebe RC, Orjiakor TC, Lasebikan N, Joseph A, Toland S, Simons A. Brain Drain in Cancer Care: The Shrinking Clinical Oncology Workforce in Nigeria. JCO Glob Oncol 2023; 9:e2300257. [PMID: 38127773 PMCID: PMC10752460 DOI: 10.1200/go.23.00257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/08/2023] [Accepted: 10/26/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE A recent estimate indicates that Nigeria has about 70 clinical oncologists (COs) providing care for 124,815 patients with cancer and its 213 million total population. This staggering deficit is likely to worsen as about 90% of Nigerian physicians are eager to leave the country for perceived greener pastures in the United States, the United Kingdom, Canada, etc. Previous studies have examined general physician migration abroad; however, the CO workforce in Nigeria has been barely considered in the workforce literature. This study examined the push and pull factors to stay or leave the CO workforce and Nigeria. METHODS Using a correlational design, 64 COs completed turnover intention (TI), workload, and satisfaction measures. Multiple linear regression was used for the data analysis. RESULTS The results show that CO workload (number of outpatients attended to; r = 0.30, P < .01) and satisfaction with the delivery of CO care (r = 0.23, P < .05) were significantly related to TI. The number of outpatients seen was also positively linked to TI. Hence, the more outpatients a CO sees, the higher the intention to leave. The United States (31%), the United Kingdom (30%), and Canada (10%) were the top countries of destinations for Nigerian COs. CONCLUSION Higher CO workload is a push factor propelling the intention to leave CO practice and relocate to other countries. Nigeria's new National Cancer Control Plan and the Federal Ministry of Health need to explore innovative approaches to attract and retain the CO workforce, which would lead to improvement in cancer survival and outcomes. Increasing the number of CO programs and positions available, improving work conditions, and introducing work benefits may mitigate the shrinking CO workforce in Nigeria.
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Affiliation(s)
- Runcie C.W. Chidebe
- Project PINK BLUE- Health & Psychological Trust Centre, Abuja, Nigeria
- Faculty of Health, Education & Life Sciences, Birmingham City University, Birmingham, United Kingdom
- Department of Sociology & Gerontology, Miami University, Miami, OH
- Scripps Gerontology Center, Miami University, Miami, OH
| | - Tochukwu C. Orjiakor
- Project PINK BLUE- Health & Psychological Trust Centre, Abuja, Nigeria
- Department of Psychology, University of Nigeria, Enugu, Nigeria
- Department of Psychology, University of Toronto, Scarborough, Canada
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Nwamaka Lasebikan
- Oncology Center, University of Nigeria Teaching Hospital, Enugu, Nigeria
- Association of Radiation & Clinical Oncologists in Nigeria (ARCON), Abuja, Nigeria
| | - Adedayo Joseph
- Association of Radiation & Clinical Oncologists in Nigeria (ARCON), Abuja, Nigeria
- NSIA—LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Samantha Toland
- The West Midlands Cancer Alliance SACT (Systemic Anti-Cancer Treatment) Expert Advisory Group, Worcester, United Kingdom
- Worcestershire Acute Hospital NHS Trust, Worcester, United Kingdom
| | - Alison Simons
- Faculty of Health, Education & Life Sciences, Birmingham City University, Birmingham, United Kingdom
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17
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Olazagasti C, Florez N. Going Back Home: Understanding Physician Migration to the United States. JCO Glob Oncol 2023; 9:e2300332. [PMID: 37944086 PMCID: PMC10645410 DOI: 10.1200/go.23.00332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Abstract
In 2021, US foreign-born population reached a high of 14.2% of the total US population. Up to 28% of US working immigrants are physicians. The decision to leave one's home country, though, is rarely an easy one to make and is often riddled with cultural and emotional challenges.
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Affiliation(s)
- Coral Olazagasti
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Narjust Florez
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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18
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Esan DT, Ayenioye OH, Ajayi PO, Sokan-Adeaga AA. Traditional birth attendants' knowledge, preventive and management practices for postpartum haemorrhage in Osun State, Southwestern Nigeria. Sci Rep 2023; 13:12314. [PMID: 37516811 PMCID: PMC10387052 DOI: 10.1038/s41598-023-39296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/22/2023] [Indexed: 07/31/2023] Open
Abstract
Traditional birth attendants (TBAs) have become an integral part of the workforce providing delivery services in Nigeria due to the limited number of skilled birth attendants and cultural preferences. This study assessed the knowledge, management and preventive practices regarding postpartum haemorrhage (PPH) among TBAs in selected communities in Osun State, Southwest Nigeria. The study employed a descriptive cross-sectional study design and recruited 260 TBAs in four communities in Osun State. Data were collected by means of an adapted semi-structured questionnaire. Data were analysed using SPSS version 23 and summarized using descriptive and inferential statistics (chi-square and logistic regression) with the level of significance set at p < 0.05. The findings indicated that most (71.4%) of the TBAs were cleric, while others were herbalist (28.6%). Although the majority (76.4%) of the TBAs had good knowledge of the causes and warning signs of PPH, a high percentage (69.3%) of TBAs had poor management practices, while 114 (64.1%) TBAs had inadequate preventive practices. Notably, almost none of the participants practised active management of the third stage of labour; the majority of TBAs did not administer any uterotonic drugs to the mother, nor did they deliver the placenta by controlled cord traction. Gender (P = 0.029), educational level (P = 0.035) and average number of births per month (P = 0.001) significantly influenced TBAs' management practices. Similarly, the TBA type (P < 0.001), average number of births per month (P = 0.003) and experience with formal training (P = 0.005) showed significant associations with TBAs' preventive practices. Furthermore, TBAs' preventive practices towards PPH were influenced by the TBA type (OR: 4.23; 95% CI 1.64-10.90). TBA management practices were also influenced by the TBA type (OR: 4.42; 95% CI 2.03-9.61). Traditional birth attendants in this study had poor management and poor preventive practices for postpartum haemorrhage.
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Affiliation(s)
- Deborah Tolulope Esan
- Department of Nursing Science, College of Health Sciences, Bowen University, P.M.B. 284, Iwo, Nigeria.
| | - Olabisi Helen Ayenioye
- Department of Nursing Science, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Paul Oladapo Ajayi
- Department of Community Medicine, Faculty of Clinical Sciences, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Adewale Allen Sokan-Adeaga
- Department of Environmental Health Science, Faculty of Basic Medical Science, Ajayi Crowther University, Oyo, Oyo State, Nigeria
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19
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Joshi R, Yakubu K, Keshri VR, Jha V. Skilled Health Workforce Emigration: Its Consequences, Ethics, and Potential Solutions. Mayo Clin Proc 2023; 98:960-965. [PMID: 37419585 DOI: 10.1016/j.mayocp.2023.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/16/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Rohina Joshi
- School of Population Health, UNSW, Sydney Australia; The George Institute for Global Health, New Delhi, India.
| | - Kenneth Yakubu
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Vikash Ranjan Keshri
- The George Institute for Global Health, New Delhi, India; The George Institute for Global Health, UNSW, Sydney, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
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20
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Groene OR, Huelmann T, Hampe W, Emami P. German Physicians and Medical Students Do Not Represent the Population They Serve. Healthcare (Basel) 2023; 11:1662. [PMID: 37372780 DOI: 10.3390/healthcare11121662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Medical professionals who represent the communities they serve are in a better position to understand patients' social circumstances and communicate in a more patient-centered way. International studies show limited diversity and underrepresentation of certain social groups in the population of physicians and medical students. We designed an observational study to investigate the cultural and socio-economic diversity of physicians and medical applicants in comparison to the general population in Germany. We invited 15,195 physicians in Hamburg and 11,287 medical applicants in Germany to participate in an online survey between June and August 2022. The lower three quintiles of objective socio-economic background (SEB) were vastly underrepresented in all subsamples of the study and in particular amongst applicants and students admitted in Hamburg: 57.9% of physicians and 73.8% of medical students in Hamburg originate from the top quintile of SEB. The Turkish and Polish communities were particularly underrepresented in the group of physicians from Hamburg and medical applicants and students in Germany (p = 0.02; p < 0.001). In line with existing evidence, the vast majority of physicians and medical students come from the most affluent households when entering medical school. Widening participation strategies are needed to facilitate fairer access to the study of medicine in Germany.
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Affiliation(s)
- Oana R Groene
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Thorben Huelmann
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Wolfgang Hampe
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Pedram Emami
- Hamburg Chamber of Physicians, 22083 Hamburg, Germany
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21
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Nguyen CV, Nguyen MH, Nguyen TT. The impact of cold waves and heat waves on mortality: Evidence from a lower middle-income country. HEALTH ECONOMICS 2023; 32:1220-1243. [PMID: 36810920 DOI: 10.1002/hec.4663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 05/04/2023]
Abstract
We estimate the impact of temperature extremes on mortality in Vietnam, using daily data on temperatures and monthly data on mortality during the 2000-2018 period. We find that both cold and heat waves cause higher mortality, particularly among older people and those living in the hot regions in Southern Vietnam. This effect on mortality tends to be smaller in provinces with higher rates of air-conditioning and emigration, and provinces with higher public spending on health. Finally, we estimate economic cost of cold and heat waves using a framework of willingness to pay to avoid deaths, then project the cost to the year 2100 under different Representative Concentration Pathway scenarios.
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Affiliation(s)
- Cuong Viet Nguyen
- International School, Vietnam National University, Hanoi, Vietnam
- Mekong Development Research Institute (MDRI), Hanoi, Vietnam
| | - Manh-Hung Nguyen
- Toulouse School of Economics, INRAE, University of Toulouse Capitole, Toulouse, France
| | - Toan Truong Nguyen
- Crawford School of Public Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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22
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Tang Y, Zhang F, Xu DR. The implications of decolonization on China's academic global health: a dialogue with Stephen Gloyd at the Luhu Global Health Salon. Glob Health Res Policy 2023; 8:14. [PMID: 37198704 PMCID: PMC10190061 DOI: 10.1186/s41256-023-00299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023] Open
Abstract
The call for decolonization in global health is growing alongside China's increasing involvement in the field. This perspective paper presents and extends with a further literature review of a dialogue with Stephen Gloyd, a global health professor from the University of Washington, conducted in July 2022 at the Luhu Global Health Salon. Drawing from Gloyd's four decades of experiences in low- and middle-income countries, as well as his role in creating the University of Washington's global health department, the doctoral program in implementation science, and the non-governmental organization, Health Alliance International, this paper delves into the concept of decolonization in global health and explores how Chinese universities can expand their participation in global health while striving for equity and justice. Focusing on China's academic global health research, education, and practice, the paper proposes specific recommendations for building an equity-focused global health curriculum, addressing power imbalances and inequalities in university-affiliated organizations, and strengthening South-South cooperation in practice. The paper offers implications for Chinese universities on expanding future global health cooperation, promoting global health governance, and avoiding recolonization.
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Affiliation(s)
- Yu Tang
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Feifei Zhang
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China.
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23
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Wang H, Zeng W, Kabubei KM, Rasanathan JJK, Kazungu J, Ginindza S, Mtshali S, Salinas LE, McClelland A, Buissonniere M, Lee CT, Chuma J, Veillard J, Matsebula T, Chopra M. Modelling the economic burden of SARS-CoV-2 infection in health care workers in four countries. Nat Commun 2023; 14:2791. [PMID: 37188709 DOI: 10.1038/s41467-023-38477-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
Health care workers (HCWs) experienced greater risk of SARS-CoV-2 infection during the COVID-19 pandemic. This study applies a cost-of-illness (COI) approach to model the economic burden associated with SARS-CoV-2 infections among HCWs in five low- and middle-income sites (Kenya, Eswatini, Colombia, KwaZulu-Natal province, and Western Cape province of South Africa) during the first year of the pandemic. We find that not only did HCWs have a higher incidence of COVID-19 than the general population, but in all sites except Colombia, viral transmission from infected HCWs to close contacts resulted in substantial secondary SARS-CoV-2 infection and death. Disruption in health services as a result of HCW illness affected maternal and child deaths dramatically. Total economic losses attributable to SARS-CoV-2 infection among HCWs as a share of total health expenditure ranged from 1.51% in Colombia to 8.38% in Western Cape province, South Africa. This economic burden to society highlights the importance of adequate infection prevention and control measures to minimize the risk of SARS-CoV-2 infection in HCWs.
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Affiliation(s)
| | - Wu Zeng
- Department of Global Health, Georgetown University, Washington, DC, USA.
| | | | | | - Jacob Kazungu
- Health Economics Research Unit, KEMRI Welcome Trust Research Program, Nairobi, Kenya
| | | | - Sifiso Mtshali
- Public Health Medicine Department, University of KwaZulu-Natal, Durban, South Africa
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Rudolfson N, Lantz A, Shrime MG, Johnson W, Smith MD, Hagander L. South Africa and the Surgical Diaspora-A Hub for Surgical Migration and Training. World J Surg 2023; 47:1684-1691. [PMID: 37029798 PMCID: PMC10083063 DOI: 10.1007/s00268-023-06990-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND The shortage of trained surgeons, anesthesiologists, and obstetricians is a major contributor to the unmet need for surgical care in low- and middle-income countries, and the shortage is aggravated by migration to higher-income countries. METHODS We performed a cross-sectional observational study, combining individual-level data of 43,621 physicians from the Health Professions Council of South Africa with data from the registers of 14 high-income countries, and international statistics on surgical workforce, in order to quantify migration to and from South Africa in both absolute and relative terms. RESULTS Of 6670 surgeons, anesthesiologists, and obstetricians in South Africa, a total of 713 (11%) were foreign medical graduates, and 396 (6%) were from a low- or middle-income country. South Africa was an important destination primarily for physicians originating from low-income countries; 2% of all surgeons, anesthesiologists, and obstetricians from low- and middle-income countries were registered in South Africa, and 6% in the other 14 recipient countries. A total of 1295 (16%) South African surgeons, anesthesiologists, and obstetricians worked in any of the 14 studied high-income countries. CONCLUSION South Africa is an important regional hub for surgical migration and training. A notable proportion of surgical specialists in South Africa were medical graduates from other low- or middle-income countries, whereas migration out of South Africa to high-income countries was even larger.
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Affiliation(s)
- Niclas Rudolfson
- Surgery and Public Health, Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Urology, Kristianstad Central Hospital, Kristianstad, Sweden.
| | - Adam Lantz
- Surgery and Public Health, Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Orthopedic Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Mark G Shrime
- Mercy Ships, Garden Valley, TX, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Walter Johnson
- Center for Global Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Martin D Smith
- Department of Surgery, University of Witwatersrand, Johannesburg, South Africa
| | - Lars Hagander
- Surgery and Public Health, Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skane University Hospital, Lund, Sweden
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25
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Bansal A, Pusey J, Shah R, Tolley A. Development and evaluation of an extra-curricular programme focussing on high impact career opportunities for medical professionals. PLoS One 2023; 18:e0284856. [PMID: 37093813 PMCID: PMC10124875 DOI: 10.1371/journal.pone.0284856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/09/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Many medical professionals seek to do good through their careers, which may involve pursuing non-clinical options such as research, policy, or education in addition to clinical work. Working out which paths will lead to the largest social impact is a challenging question and of interest to many doctors. However, there are few, if any, services that use an impact-oriented framework to support doctors who want to make career decisions based on impact. OBJECTIVES To describe the development of an 8-week fellowship programme to introduce medical professionals to careers paths and focus areas which could lead to a particularly large social impact. And to evaluate the programme in terms of engagement, utility, changes in knowledge and career attitudes of participants. METHODS The ADDIE instructional design model was used to design and evaluate this fellowship programme. An 8-week curriculum was designed by medical professionals and delivered to medical students and doctors around the world utilising a flipped learning style. Quantitative and qualitative data on the programme were collected and analysed. RESULTS There was more demand for the programme than anticipated. We found that the fellowship was engaging and useful to medical students and doctors. It resulted in an increase in knowledge and skills on how to consider impact in one's own career and a change in participants' attitudes and behaviours, with some participants making changes to their career and charitable giving following the programme. CONCLUSIONS We believe an impact-orientated, practical co-curricular programme is valuable to medical professionals exploring impactful career options and there is demand for further programmes in this space.
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Affiliation(s)
- Akhil Bansal
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Joseph Pusey
- Bolton NHS Foundation Trust, Bolton, United Kingdom
| | - Rahul Shah
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Abraham Tolley
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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Onah CK, Azuogu BN, Ochie CN, Akpa CO, Okeke KC, Okpunwa AO, Bello HM, Ugwu GO. Physician emigration from Nigeria and the associated factors: the implications to safeguarding the Nigeria health system. HUMAN RESOURCES FOR HEALTH 2022; 20:85. [PMID: 36539827 PMCID: PMC9764293 DOI: 10.1186/s12960-022-00788-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Adequate Human Resources for Health is indispensable to achieving Universal Health Coverage and physicians play a leading role. Nigeria with low physician-population ratio, is experiencing massive exodus of physicians. This study investigated emigration intention of physicians, the factors influencing it and discussed the implications to guide policy formulation and reforms, curtail the trend and safeguard the country's health system. METHODS Through cross-sectional survey, 913 physicians from 37 States were interviewed with semi-structured questionnaire using Google form shared via WhatsApp and Telegram forums of Nigeria Medical Association. Data were analysed with IBM-SPSS version-25 and charts were created with Microsoft-Excel. Chi-square and multiple regression tests were done with p-value set at 0.05. RESULTS The mean age of respondents is 37.6 ± 7.9 years; majority of them are males (63.2%), married (75.5%) with postgraduate qualifications (54.1%) and working in public health facilities (85.4%). Whereas 13% and 19.3% are, respectively, satisfied with their work and willing to continue practice in Nigeria, 43.9% want to emigrate and 36.8% are undecided about future location of their practice. The commonest reasons for emigration are poor remuneration (91.3%), rising insecurity (79.8%) and inadequate diagnostic facilities (61.8%). Physicians working in public health facilities are 2.5 times less satisfied than their counterparts in non-public sector (AOR = 0.4; 95% CI = 0.3-0.8). Physicians in their thirties, forties and fifties are 3.5 (95% CI = 1.5-8.0), 5.5 (95% CI = 2.1-14.5) and 13.8 (95% CI = 3.9-49.3) times, respectively, more willing to retain practice in Nigeria than those younger and those satisfied with their work are 4.7 (AOR = 4.7, 95% CI = 2.9-7.4) times more willing to practice in Nigeria than those not satisfied. CONCLUSION Majority of Nigerian physicians want to emigrate for professional practice and top among the push factors are poor remuneration, rising insecurity and inadequate diagnostic facilities. The observed trend portends danger to the country's health system due to the foreseeable negative consequences of physician deficit to the system. We recommend upward review of physician remuneration, a root cause analysis of insecurity to determine workable preventive measures and increased funding of the health sector to improve the diagnostic infrastructure, retain physicians and save the health system from imminent collapse.
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Affiliation(s)
- Cosmas Kenan Onah
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
| | - Benedict Ndubueze Azuogu
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
- Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Casmir Ndubuisi Ochie
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - Christian Obasi Akpa
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Kingsley Chijioke Okeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Anthony Okoafor Okpunwa
- Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital Parklane, Enugu, Nigeria
| | - Hassan Muhammad Bello
- Department of Community Medicine, Federal Teaching Hospital, Gombe, Gombe State, Nigeria
| | - George Onyemaechi Ugwu
- Department of Obstetrics and Gynaecology, University of Nigeria, Nsukka, Enugu State, Nigeria
- Enugu State Primary Health Care Development Agency, Enugu, Nigeria
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Timothy J, Ivanov M, Tisell M, Marchesini N, Lafuente J, Foroglou N, Visocchi M, Olldashi F, Gonzalez-Lopez P, Rzaev J, Whitfield P, Peul WC, Rasulic L, Demetriades AK. Working in low- and middle-income countries: Learning from each other. BRAIN & SPINE 2022; 2:101689. [PMID: 36506295 PMCID: PMC9729805 DOI: 10.1016/j.bas.2022.101689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/02/2022] [Accepted: 11/01/2022] [Indexed: 11/05/2022]
Abstract
•Barriers may limit LMICs-HICs collaborations: infrastructure, equipment's lack/inadequacy, political issues, brain drain.•Local training is crucial for universal health coverage; several activities are headed by Global Neurosurgery organisations.•The EANS Global and Humanitarian Neurosurgery Committee aims to become a gateway for partnerships between HICs and LMICs.
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Affiliation(s)
- Jake Timothy
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Marcel Ivanov
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,Department of Neurosurgery, Sheffield Teaching Hospital, NHS Foundation Trust, UK
| | - Magnus Tisell
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,Department of Neurosurgery, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Nicolò Marchesini
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,Department of Neurosurgery, University Hospital Borgo Trento, Verona, Italy,Corresponding author. Department of Neurosurgery, University Hospital Borgo Trento, Piazzale Stefani 1, 37126, Verona, Italy.
| | - Jesus Lafuente
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,Spine Center, Hospital Del Mar, Barcelona, Spain
| | - Nikos Foroglou
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,Department of Neurosurgery, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Massimiliano Visocchi
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,CVJ Surgery Unit, Institute of Neurosurgery, Catholic University of Rome, Italy
| | - Fatos Olldashi
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,Department of Neurosurgery, University Hospital of Trauma, Tirana, Albania
| | - Pablo Gonzalez-Lopez
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,Department of Neurosurgery, General University Hospital Alicante, Alicante, Spain
| | - Jamil Rzaev
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,Federal Neurosurgical Center, Novosibirsk, Russian Federation
| | - Peter Whitfield
- Department of Neurosurgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Wilco C. Peul
- University Neurosurgical Center Holland, HMC-HAGA The Hague & LUMC Leiden, Netherlands
| | - Lukas Rasulic
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,Faculty of Medicine, University of Belgrade, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Andreas K. Demetriades
- Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), UK,Department of Neurosurgery, Royal Infirmary, Edinburgh, UK
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Kamarulzaman A, Ramnarayan K, Mocumbi AO. Plugging the medical brain drain. Lancet 2022; 400:1492-1494. [PMID: 36522198 PMCID: PMC9612885 DOI: 10.1016/s0140-6736(22)02087-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Adeeba Kamarulzaman
- Infectious Diseases Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia.
| | | | - Ana Olga Mocumbi
- Universiddae Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
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29
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Elmer D, Endrei D, Németh N, Horváth L, Pónusz R, Kívés Z, Danku N, Csákvári T, Ágoston I, Boncz I. Changes in the Number of Physicians and Hospital Bed Capacity in Europe. Value Health Reg Issues 2022; 32:102-108. [PMID: 36170790 DOI: 10.1016/j.vhri.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/16/2022] [Accepted: 07/16/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Our aim was to examine the numbers of practicing physicians and total numbers of hospital beds in European Organisation for Economic Co-operation and Development countries. METHODS Data analyzed were derived from the "Organisation for Economic Co-operation and Development Health Statistics 2020" database between 1980 and 2018. The selected countries were compared according to the type of healthcare system and geographical location by parametric and nonparametric tests. RESULTS In 1980, Bismarck-type systems showed an average number of physicians of 2.3 persons/1000 population; in Beveridge-type systems, it was 1.7 persons. By 2018, it leveled out reaching 3.9 persons in both healthcare system types. In 1980, average physician number/1000 was 2.5 persons in Eastern Europe; in Western Europe, it was 1.9 persons. By 2018 this proportion changed with Western Europe having the higher number (3.7 persons; 3.9 persons). In 1980, average number of hospital beds/1000 population was 9.6 in Bismarck-type systems whereas in Beveridge-type systems it was 8.8. By 2018, it decreased to 5.6 in Bismarck-type systems (-42%) and to 3.1 in Beveridge-type systems (-65%). In 1980, the average number of hospital beds/1000 population in Eastern Europe was 10.3; in Western Europe, it was 8.5. By 2018, the difference between the 2 regions did not change. CONCLUSIONS Although the number of physicians was 33% higher in 1980 in Eastern Europe than in Western Europe, by 2018 the number of physicians was 5% higher in Western Europe. In general, regardless of the healthcare system and geographical location, the proportion of physicians per 1000 population has improved due to a larger decrease in the number of hospital beds.
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Affiliation(s)
- Diána Elmer
- Institute for Health Insurance, University of Pécs, Pécs, Hungary.
| | - Dóra Endrei
- Institute for Health Insurance, University of Pécs, Pécs, Hungary
| | - Noémi Németh
- Institute for Health Insurance, University of Pécs, Pécs, Hungary
| | - Lilla Horváth
- Institute for Health Insurance, University of Pécs, Pécs, Hungary
| | - Róbert Pónusz
- Institute for Health Insurance, University of Pécs, Pécs, Hungary
| | - Zsuzsanna Kívés
- Institute for Health Insurance, University of Pécs, Pécs, Hungary
| | - Nóra Danku
- Institute for Health Insurance, University of Pécs, Pécs, Hungary
| | - Tímea Csákvári
- Institute for Health Insurance, University of Pécs, Zalaegerszeg, Hungary
| | - István Ágoston
- Institute for Health Insurance, University of Pécs, Pécs, Hungary
| | - Imre Boncz
- Institute for Health Insurance, University of Pécs, Pécs, Hungary
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Murataj N, Syla B, Krasniqi Y, Bahtiri S, Bekaj D, Beqiri P, Hoxha IS. Migration Intent of Health Care Workers during the COVID-19 Pandemic in Kosovo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11122. [PMID: 36078833 PMCID: PMC9518021 DOI: 10.3390/ijerph191711122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
The migration of healthcare workers from developing countries to more economically developed countries is a long-standing and ongoing trend. Loss of qualified staff due to migration can negatively impact healthcare systems. Understanding factors that drive migration is essential to identifying and managing health system needs. Our study explored factors related to the migration intent of healthcare staff in Kosovo, particularly after the COVID-19 pandemic. We carried out a cross-sectional survey of healthcare workers from public and private institutions. The survey analysed the prevalence of willingness to migrate and whether willingness was affected by the pandemic, and calculated crude and adjusted odds ratios for variables which may influence migration willingness. 14.43% of healthcare workers reported aspiration to migrate, and 23.68% reported an increased chance of migrating after the pandemic. Dissatisfaction with wages and working conditions, higher education and private sector engagement were associated with increased odds of migration willingness. After the pandemic, factors related to interpersonal relationships and state response gave lower odds of migration intent. These findings point to potential factors associated with the migration of healthcare workers, which can help policymakers address gaps in national health system strategy.
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Affiliation(s)
- Nora Murataj
- Federata e Sindikatave të Shëndetësisë së Kosovës, 10000 Prishtina, Kosovo
| | - Blerim Syla
- Federata e Sindikatave të Shëndetësisë së Kosovës, 10000 Prishtina, Kosovo
| | - Yllka Krasniqi
- Federata e Sindikatave të Shëndetësisë së Kosovës, 10000 Prishtina, Kosovo
| | - Shegë Bahtiri
- Institute of South East Europe for Health and Social Policy, 10000 Prishtina, Kosovo
| | - Dardan Bekaj
- Institute of South East Europe for Health and Social Policy, 10000 Prishtina, Kosovo
| | - Petrit Beqiri
- Advanced Nursing Practices Department, Heimerer College, 10000 Prishtina, Kosovo
| | - Ilir S. Hoxha
- Research Unit, Heimerer College, 10000 Prishtina, Kosovo
- Evidence Synthesis Group, 10000 Prishtina, Kosovo
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, USA
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31
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Miranda-Schaeubinger M, Noor A, Leitão CA, Otero HJ, Dako F. Radiology for Thoracic Conditions in Low- and Middle-Income Countries. Thorac Surg Clin 2022; 32:289-298. [PMID: 35961737 DOI: 10.1016/j.thorsurg.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
With a disproportionately high burden of global morbidity and mortality caused by chronic respiratory diseases (CRDs) in low and middle-income countries (LMICs), access to radiological services is of critical importance for screening, diagnosis, and treatment guidance.
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Affiliation(s)
- Monica Miranda-Schaeubinger
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA. https://twitter.com/MonicaMirandaSc
| | - Abass Noor
- Department of Radiology, University of Pennsylvania, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19104, USA. https://twitter.com/ceelwaaq
| | - Cleverson Alex Leitão
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Paraná, Brazil
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA. https://twitter.com/oterocobo
| | - Farouk Dako
- Department of Radiology, University of Pennsylvania, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Kumar M, Atwoli L, Burgess RA, Gaddour N, Huang KY, Kola L, Mendenhall E, Mugo C, Mutamba BB, Nakasujja N, Njuguna I, Obasi A, Petersen I, Shidhaye R. What should equity in global health research look like? Lancet 2022; 400:145-147. [PMID: 35597247 DOI: 10.1016/s0140-6736(22)00888-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Manasi Kumar
- Brain and Mind Institute, Aga Khan University, Nairobi 00100, Kenya.
| | - Lukoye Atwoli
- Brain and Mind Institute, Aga Khan University, Nairobi 00100, Kenya; School of Medicine, Aga Khan University, Nairobi 00100, Kenya
| | | | - Naoufel Gaddour
- Department of Psychiatry, University of Monastir, Monastir, Tunisia
| | - Keng Yen Huang
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Lola Kola
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Emily Mendenhall
- Edmund A Walsh School of Foreign Service, Georgetown University, Washington DC, USA
| | - Cyrus Mugo
- Research Department, Kenyatta National Hospital, Nairobi, Kenya
| | | | | | - Irene Njuguna
- Research Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Inge Petersen
- Center for Rural Health, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Rahul Shidhaye
- Department of Psychiatry, Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra, India
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33
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Garbern SC, Hyuha G, González Marqués C, Baig N, Chan JL, Dutta S, Gulamhussein MA, López Terán GP, Manji HK, Mdundo WK, Moresky RT, Mussa RY, Noste EE, Nyirenda M, Osei-Ampofo M, Rajeev S, Sawe HR, Simbila AN, Thilakasiri MCK, Turgeon N, Wachira BW, Yang RS, Yussuf A, Zhang R, Zyer A, Rees CA. Authorship representation in global emergency medicine: a bibliometric analysis from 2016 to 2020. BMJ Glob Health 2022; 7:bmjgh-2022-009538. [PMID: 35760436 PMCID: PMC9237874 DOI: 10.1136/bmjgh-2022-009538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field. Methods We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors’ affiliations and funding sources. We compared the proportion of authors affiliated with each income bracket using Χ2 analysis. We conducted logistic regression to identify factors associated with first or last authorship affiliated with the study country. Results There were 14 113 authors in 1751 articles. Nearly half (45.5%) of the articles reported work conducted in lower middle-income countries (MICs), 23.6% in upper MICs, 22.5% in low-income countries (LICs). Authors affiliated with HICs were most represented (40.7%); 26.4% were affiliated with lower MICs, 17.4% with upper MICs, 10.3% with LICs and 5.1% with mixed affiliations. Among single-country studies, those without any local authors (8.7%) were most common among those conducted in LICs (14.4%). Only 31.0% of first authors and 21.3% of last authors were affiliated with LIC study countries. Studies in upper MICs (adjusted OR (aOR) 3.6, 95% CI 2.46 to 5.26) and those funded by the study country (aOR 2.94, 95% CI 2.05 to 4.20) had greater odds of having a local first author. Conclusions There were significant disparities in authorship representation. Authors affiliated with HICs more commonly occupied the most prominent authorship positions. Recognising and addressing power imbalances in international, collaborative emergency medicine (EM) research is warranted. Innovative methods are needed to increase funding opportunities and other support for EM researchers in LMICs, particularly in LICs.
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Affiliation(s)
- Stephanie Chow Garbern
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Gimbo Hyuha
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Catalina González Marqués
- Division of Global Emergency Medicine and Humanitarian Studies, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Noor Baig
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Jennifer L Chan
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois, USA.,CrisisReady, Boston, Massachusetts, USA
| | - Sanjukta Dutta
- Department of Emergency Medicine, Fortis Hospital, Kolkata, India
| | - Masuma A Gulamhussein
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Gloria Paulina López Terán
- Servicio de Emergencia, Hospital Santa Inés de Ambato, Ambato, Ecuador.,Servicio de Emergencia, Hospital General Ambato, Ambato, Ecuador
| | - Hussein Karim Manji
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.,Accident and Emergency Department, Aga Khan Hospital, Dar es Salaam, United Republic of Tanzania
| | - Winnie K Mdundo
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Rachel T Moresky
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.,Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA
| | - Raya Yusuph Mussa
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Erin E Noste
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
| | - Mulinda Nyirenda
- Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, Ministry of Health - Malawi, Blantyre, Malawi.,Emergency Medicine Unit, Department of Internal Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Maxwell Osei-Ampofo
- Emergency Medical Services, Ghana National Ambulance Service, Accra, Ghana.,Department of Internal Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Sindhya Rajeev
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Alphonce Nsabi Simbila
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | | | - Nikkole Turgeon
- University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Benjamin W Wachira
- Accident & Emergency Department, The Aga Khan University, Nairobi, Kenya
| | - Rebecca S Yang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amne Yussuf
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Raina Zhang
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alishia Zyer
- Bryant University, Smithfield, Rhode Island, USA
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Venn SN, Mabedi C, Ngowi BN, Mbwambo OJ, Mteta KA, Payne SR. Disseminating surgical experience for sustainable benefits - the Urolink experience. BJU Int 2022; 129:661-667. [PMID: 35349222 DOI: 10.1111/bju.15733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
The dissemination of urological knowledge, and consequent surgical expertise, is entirely dependent on the availability of individuals to provide education and the mechanism by which that knowledge is spread. In low, or low-middle, income countries the numbers of specialist surgeons, especially urologists, is extremely limited and the time they have to train aspiring urologists is, therefore, restricted as a consequence of the demand for clinical help. Urologists from high-income countries, being more prevalent, can assist with the education, but are limited by the needs of their own careers and the time they have available to educate in a resource poor setting. Bringing surgeons from a low to a high income environment for training is one option to overcome this trainer/trainee imbalance, but is relatively expensive, bureaucratic, and has inherent risks of the individual being lost from their domestic workforce. Short-term medical trips to educate larger numbers of individuals in their home setting is one of a number of different options that has been used to bridge this gap. It has, however, been suggested that such a model is not the most efficient way of perpetuating knowledge and skills in a low-income environment. Urolink has found, however, that when short term trips are used to support a longitudinal commitment to a centre they can be remarkable effective. By helping the expansion of personnel to a critical mass in designated regional hubs, linked to credible local or regional academic institutions, it has been possible to develop sustainable centres that can disseminate training across a wide geographical area. Such a co-operative approach has been used between Urolink and the Kilimanjaro Christian Medical Centre in Moshi, Tanzania, a model that has initiated the evolution of other regional training hubs across east Africa over the last three decades.
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Affiliation(s)
- Suzie N Venn
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK.,Urolink, British Association of Urological Surgeons
| | | | | | - Orgeness J Mbwambo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College
| | - Kien Alfred Mteta
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College
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35
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Faulkenberry JG, Luberti A, Craig S. Electronic health records, mobile health, and the challenge of improving global health. Curr Probl Pediatr Adolesc Health Care 2022; 52:101111. [PMID: 34969611 DOI: 10.1016/j.cppeds.2021.101111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Technology continues to impact healthcare around the world. This provides great opportunities, but also risks. These risks are compounded in low-resource settings where errors in planning and implementation may be more difficult to overcome. Global Health Informatics provides lessons in both opportunities and risks by building off of general Global Health. Global Health Informatics also requires a thorough understanding of the local environment and the needs of low-resource settings. Forming effective partnerships and following the lead of local experts are necessary for sustainability; it also ensures that the priorities of the local community come first. There is an opportunity for partnerships between low-resource settings and high income areas that can provide learning opportunities to avoid the pitfalls that plague many digital health systems and learn how to properly implement technology that truly improves healthcare.
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Affiliation(s)
- J Grey Faulkenberry
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia.
| | - Anthony Luberti
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
| | - Sansanee Craig
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
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36
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Turner J, Duffy S. Orthopaedic and trauma care in low-resource settings: the burden and its challenges. INTERNATIONAL ORTHOPAEDICS 2022; 46:143-152. [PMID: 34655318 DOI: 10.1007/s00264-021-05236-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND BURDEN Trauma with its early and late consequences disproportionately effects those from poor countries. The availability of effective orthopaedic and trauma care varies significantly across the globe. CHALLENGES The balancing out of quality care is required to reach the health-related UN development goal set out in 2015. A multifactorial approach addressing local, national and international aspects is key to improving the discrepancy seen between high- and low-income countries.
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Affiliation(s)
- James Turner
- Bristol Royal Hospital for Children, Bristol, UK.
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37
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Hill E, Gurbutt D, Makuloluwa T, Gordon M, Georgiou R, Roddam H, Seneviratne S, Byrom A, Pollard K, Abhayasinghe K, Chance-Larsen K. Collaborative healthcare education programmes for continuing professional education in low and middle-income countries: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 65. MEDICAL TEACHER 2021; 43:1228-1241. [PMID: 34499841 DOI: 10.1080/0142159x.2021.1962832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Large discrepancies exist between standards of healthcare provision in high-income (HICs) and low and middle-income countries (LMICs). The root cause is often financial, resulting in poor infrastructure and under-resourced education and healthcare systems. Continuing professional education (CPE) programmes improve staff knowledge, skills, retention, and practice, but remain costly and rare in low-resource settings. One potential solution involves healthcare education collaborations between institutions in HICs and LMICs to provide culturally appropriate CPE in LMICs. To be effective, educational partnerships must address the challenges arising from differences in cultural norms, language, available technology and organisational structures within collaborating countries. METHODS Seven databases and other sources were systematically searched on 7 July 2020 for relevant studies. Citations, abstracts, and studies were screened and consensus was reached on which to include within the review. 54 studies were assessed regarding the type of educational programme involved, the nature of HIC/LMIC collaboration and quality of the study design. RESULTS Studies varied greatly regarding the types and numbers of healthcare professionals involved, pedagogical and delivery methods, and the ways in which collaboration was undertaken. Barriers and enablers of collaboration were identified and discussed. The key findings were: 1. The methodological quality of reporting in the studies was generally poor. 2. The way in which HIC/LMIC healthcare education collaboration is undertaken varies according to many factors, including what is to be delivered, the learner group, the context, and the resources available. 3. Western bias was a major barrier. 4. The key to developing successful collaborations was the quality, nature, and duration of the relationships between those involved. CONCLUSION This review provides insights into factors that underpin successful HIC/LMIC healthcare CPE collaborations and outlines inequities and quality issues in reporting.
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Affiliation(s)
- Elaine Hill
- School of Sport and Health Sciences, UCLan, Preston, UK
| | - Dawne Gurbutt
- Centre for Collaborative Learning, UCLan, Preston, UK
| | - Thamasi Makuloluwa
- Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | | | | | - Hazel Roddam
- School of Sport and Health Sciences, UCLan, Preston, UK
| | - Sujatha Seneviratne
- Department of Nursing and Midwifery, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Anna Byrom
- School of Community Health and Midwifery, UCLan, Preston, UK
| | - Kerry Pollard
- School of Community Health and Midwifery, UCLan, Preston, UK
| | - Kalpani Abhayasinghe
- Department of Nursing and Midwifery, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
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Abstract
BACKGROUND Orofacial clefts are one of the most common congenital anomalies, but this disease burden is unevenly distributed worldwide. The authors hypothesize that this burden falls disproportionately on the countries with the smallest surgical workforce or lowest Socio-Demographic Index, rather than those with the highest prevalence of disease. METHODS The authors estimated the prevalence and disease burden of orofacial clefting from 1990 to 2017 in 195 countries using the Global Burden of Disease methodology. Prevalence and disability-adjusted life-years were compared geographically, temporally, and against the size of the national surgical workforce, Socio-Demographic Index, and income status. Linear and logarithmic regressions were performed. RESULTS In 2017, the prevalence of orofacial clefting was estimated to be 10.8 million people, representing a disease burden of 652,084 disability-adjusted life-years, with most of this disease burden experienced by low- and middle-income countries (94.1%). From 1990 to 2017, there was a decrease in disease burden (-70.2%) and prevalence (-4.9%). There was negative logarithmic association between surgical workforce size and disease burden, with a surgical workforce of greater than six providers per 100,000 population (3.6 disability-adjusted life-years versus 22.4 disability-adjusted life-years per 100,000 population; p < 0.0001). CONCLUSIONS Burden of orofacial clefting has a strong negative association with the size of the surgical workforce, suggesting that strengthening the surgical workforce will help alleviate this burden. Epidemiologic data on countries and regions with inadequate surgical workforces and high disease burden should guide future research efforts and allocation of resources, and guide the treatment and educational goals of international charitable organizations.
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39
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Suarez S. Physician shortages and its impact on brain drain: a response to Roy et al. J Immigr Minor Health 2021; 23:883-884. [PMID: 34324123 DOI: 10.1007/s10903-021-01255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Sebastian Suarez
- Internal Medicine Residency Program, Department of Medicine, Boston University Medical Center, 72 East Concord Street, Evans 124, Boston, MA, 02118, USA.
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40
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Fagan JJ. Africa: A window on challenges and opportunities for head and neck cancer. Laryngoscope Investig Otolaryngol 2021; 6:414-419. [PMID: 34195361 PMCID: PMC8223454 DOI: 10.1002/lio2.554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Head and neck cancer occurs predominantly in the Developing World, with significant challenges relating to a high burden of disease, late presentation, and poor access to curative and palliative care. AIMS This article describes challenges relating to head and neck cancer care in Sub-Saharan Africa. MATERIAL & METHODS Educational and training innovations that have been undertaken to improve access to cancer care are presented under the following headings: Open Access Educational Resources African Head and Neck Society (AfHNS); African head and neck surgery fellowship training; AfHNS Virtual Tumor Board; The AfHNS Clinical Practice Guidelines for Head & Neck Cancers in Developing Countries and Limited Resource Settings. Concerns are also raised about universally applicable cancer staging systems. RESULTS The challenges facing African patients apply to equally to many other parts of the developing world. DISCUSSION The challenges facing African patients apply to equally to many other parts of the developing world. CONCLUSIONS For outcomes of head and neck cancers to be improved globally, a far greater investment needs to be made in education and training to improve access to care in developing countries. To make a meaningful global impact on morbidity and mortality related to HNC, clinicians, academic institutions and professional societies in developed countries need to be sensitive to these developing world challenges and should directly engage in improving access to care through promoting open access educational resources, offering specialist and fellowship training, collaborating with appropriate research, and establishing and strengthening centers of excellence in developing countries. LEVEL OF EVIDENCE 2c "Outcomes research".
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Affiliation(s)
- Johannes J. Fagan
- Division of Otorhinolaryngology, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
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41
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Deng D, Naslund JA. Psychological Impact of COVID-19 Pandemic on Frontline Health Workers in Low- and Middle-Income Countries. HARVARD PUBLIC HEALTH REVIEW (CAMBRIDGE, MASS.) 2020; 28:http://harvardpublichealthreview.org/wp-content/uploads/2020/10/Deng-and-Naslund-2020-28.pdf. [PMID: 33409499 PMCID: PMC7785092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Healthcare systems in many countries have been overwhelmed by the coronavirus disease (COVID-19) pandemic, with increasing demands to contain and respond to the virus. The result has been increased pressure on frontline health workers. As the pandemic unfolds, the impact on health systems in low-income and middle-income countries (LMICs) is becoming apparent. In lower resource settings, the detrimental effects on frontline health workers will likely be significant due to fragmented infrastructure, low compensation, and significant shortages of necessary resources such as personal protective equipment. These high stress conditions, coupled with risk of infection and fears and anxieties among patients, can result in grave psychosocial consequences for frontline health workers, who play a vital role in delivering the bulk of primary care services in LMICs. In this narrative review, we consider the psychological impact of the COVID-19 pandemic on frontline health workers in LMICs. We describe the important role of frontline health workers, summarize existing literature on burnout and risks to mental health in this essential workforce, and consider how public health emergencies exacerbate these concerns to showcase their vulnerability to mental health impacts of COVID-19. We explore emerging research on the detrimental effects of the COVID-19 pandemic on health workers and consider possible approaches to mitigate these consequences. This review draws from existing studies and emerging evidence to highlight the critical need to consider the wellbeing of frontline health workers, and to address these challenges as health systems respond to the pandemic.
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Affiliation(s)
- Davy Deng
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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