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Qamar W, Qayum M, Nisa WU, Ali A. Perceived outcomes of medical teaching institute reforms: insights from management, faculty, and administration in Pakistani tertiary health care. BMC Health Serv Res 2024; 24:1061. [PMID: 39272050 PMCID: PMC11396421 DOI: 10.1186/s12913-024-11416-y] [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: 06/06/2024] [Accepted: 08/08/2024] [Indexed: 09/15/2024] Open
Abstract
OBJECTIVE The study aims to explore the perceived outcomes of Medical Teaching Institution (MTI) reforms on autonomy and overall performance within tertiary healthcare institutions in Khyber Pakhtunkhwa (KP) province, Pakistan. METHODOLOGY A cross-sectional study was carried out from September 2023 to March 2024, involving interviews with frontline staff, administrative personnel, and senior management within MTI-affiliated institutions. The methodology employed, using both qualitative and quantitative data analysis techniques. RESULTS The study showed that institutional staff members' knowledge and understanding of the MTI changes differed. Some observed very minor adjustments, while others saw advances in hospital operations and service delivery. Administrative complexity, political meddling, and resource allocation problems were noted as challenges. Positive results were also observed, though, and they included improved infrastructure, possibilities for staff training, and decision-making procedures. CONCLUSION Despite significant improved, there are still challenges, such as inconsistent staff comprehension, mixed impacts on service delivery, resource allocation issues, and political meddling. Addressing these issues necessitates improved communication, continuous evaluation, and coordinated efforts to improve administrative systems and obtain consistent funding.
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Affiliation(s)
- Wajiha Qamar
- Department of Oral Biology, Bacha Khan College of Dentistry, Mardan, Pakistan.
| | - Mehran Qayum
- Evidence for Health (E4H) Programme Khyber Pakhtunkhwa, Oxford Policy Management, Peshawar, Pakistan
| | - Waqar-Un Nisa
- Department of Oral Pathology, Bacha Khan College of Dentistry, Mardan, Pakistan
| | - Asma Ali
- Department of Oral Biology, Bacha Khan College of Dentistry, Mardan, Pakistan
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McGivern G, Wafula F, Seruwagi G, Kiefer T, Musiega A, Nakidde C, Ogira D, Gill M, English M. Deconcentrating regulation in low- and middle-income country health systems: a proposed ambidextrous solution to problems with professional regulation for doctors and nurses in Kenya and Uganda. HUMAN RESOURCES FOR HEALTH 2024; 22:13. [PMID: 38308369 PMCID: PMC10835984 DOI: 10.1186/s12960-024-00891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/08/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Regulation can improve professional practice and patient care, but is often weakly implemented and enforced in health systems in low- and middle-income countries (LMICs). Taking a de-centred and frontline perspective, we examine national regulatory actors' and health professionals' views and experiences of health professional regulation in Kenya and Uganda and discuss how it might be improved in LMICs more generally. METHODS We conducted large-scale research on professional regulation for doctors and nurses (including midwives) in Uganda and Kenya during 2019-2021. We interviewed 29 national regulatory stakeholders and 47 subnational regulatory actors, doctors, and nurses. We then ran a national survey of Kenyan and Ugandan doctors and nurses, which received 3466 responses. We thematically analysed qualitative data, conducted an exploratory factor analysis of survey data, and validated findings in four focus group discussions. RESULTS Kenyan and Ugandan regulators were generally perceived as resource-constrained, remote, and out of touch with health professionals. This resulted in weak regulation that did little to prevent malpractice and inadequate professional education and training. However, interviewees were positive about online licencing and regulation where they had relationships with accessible regulators. Building on these positive findings, we propose an ambidextrous approach to improving regulation in LMIC health systems, which we term deconcentrating regulation. This involves developing online licencing and streamlining regulatory administration to make efficiency savings, freeing regulatory resources. These resources should then be used to develop connected subnational regulatory offices, enhance relations between regulators and health professionals, and address problems at local level. CONCLUSION Professional regulation for doctors and nurses in Kenya and Uganda is generally perceived as weak. Yet these professionals are more positive about online licencing and regulation where they have relationships with regulators. Building on these positive findings, we propose deconcentrating regulation as a solution to regulatory problems in LMICs. However, we note resource, cultural and political barriers to its effective implementation.
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Affiliation(s)
| | | | | | - Tina Kiefer
- University of Warwick, Coventry, United Kingdom
| | | | | | | | - Mike Gill
- University of Oxford, Oxford, United Kingdom
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Mondal H, Soni S, Juyal A, Behera JK, Mondal S. Current distribution of medical colleges in India and its potential predictors: A public domain data audit. J Family Med Prim Care 2023; 12:1072-1077. [PMID: 37636164 PMCID: PMC10451585 DOI: 10.4103/jfmpc.jfmpc_1558_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/13/2022] [Accepted: 10/12/2022] [Indexed: 08/29/2023] Open
Abstract
Background A teaching hospital or medical college may help provide better health care delivery to the people of the vicinity. Hence, building new medical colleges and upgrading existing hospitals to teaching hospitals are being implemented in India. Objective This study aimed to observe the current distribution of medical colleges in Indian states and find correlation with area, population, and net state domestic product (NSDP). Methods We collected data from public domain websites provided by government agencies. The State-wise number of government and private medical colleges and their annual intake were obtained from the National Medical Commission website. The state-wise number of medical colleges, geographical area, and population were calculated as the percentage of total Indian colleges, area, and population, respectively. Spearman's correlation was calculated to find any correlation of colleges and annual intake versus parameters such as area, population, and NSDP. Results India has a total of 612 [321 (52.45%) government-run and 291 (47.55%) private] medical colleges. Tamil Nadu (70), Uttar Pradesh (67), Karnataka (63), Maharashtra (62), and Telangana (34) are the top five states with 296 (48.37%) medical colleges. States and union territories such as Karnataka, Kerala, Maharashtra, Puducherry, Tamil Nadu, and Telangana have higher medical colleges, and states such as Assam, Bihar, Odisha, Madhya Pradesh, Rajasthan, and Uttar Pradesh have lower medical colleges when compared with their population percentages. There was significant positive correlation of number of medical colleges with area (rs = 0.769, P < 0.0001), population (rs = 0.91, P < 0.0001), and NSDP (rs = 0.91, P < 0.0001). Conclusion The current distribution of medical colleges in India is clustered over some states. Although geographical area and population are major predictors of medical colleges in Indian states, a more population-based balanced distribution of medical colleges would help distribute quality health care to the majority of the population.
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Affiliation(s)
- Himel Mondal
- Department of Physiology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Sachin Soni
- Department of Anatomy, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Ankita Juyal
- Department of Physiology, Soban Singh Jeena Government Institute of Medical Science and Research, Almora, Uttarakhand, India
| | - Joshil K. Behera
- Department of Physiology, Government Medical College and Hospital, Keonjhar, Odisha, India
| | - Shaikat Mondal
- Department of Physiology, Raiganj Government Medical College and Hospital, West Bengal, India
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Saxena SG, Godfrey T. India's Opportunity to Address Human Resource Challenges in Healthcare. Cureus 2023; 15:e40274. [PMID: 37448434 PMCID: PMC10336366 DOI: 10.7759/cureus.40274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
India's health indicators have improved in recent times but continue to lag behind those of its peer nations. The country with a population of 1.3 billion, has an estimated active health workers density of doctors and nurses/midwives of 5.0 and 6.0 respectively, for 10,000 persons, which is much lower than the WHO threshold of 44.5 doctors, nurses, and midwives per 10,000 population. The issue is compounded by the skewed inter-state, urban-rural, and public-private sector divide. Calls to urgently augment the skilled health workforce reinforce the central role human resources have in healthcare, which has evolved into a complex multifactorial issue. The paucity of skilled personnel must be addressed if India is to accelerate its progress toward achieving universal health coverage and its sustainable development goals (SDGs). The recent increase in the federal health budget offers an unprecedented opportunity to do this. This article utilizes the ready materials, extract and analyze data, distill findings (READ) approach to adding to the authors' experiential learning to analyze the health system in India. The growing divide between the public and the burgeoning private health sector systems, with the latter's booming medical tourism industry and medical schools, are analyzed along with the newly minted National Medical Council, to recommend policies that would help India achieve its SDGs.
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Affiliation(s)
| | - Thomas Godfrey
- Public Health Sciences, Penn State College of Medicine, Hershey, USA
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Theerth K, Jadon A, D'souza N, Jana J. National board governed post-graduate curriculum: Strengths and scope. Indian J Anaesth 2022; 66:20-26. [PMID: 35309021 PMCID: PMC8929313 DOI: 10.4103/ija.ija_1096_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/08/2022] [Accepted: 01/08/2022] [Indexed: 11/06/2022] Open
Abstract
The National Board of Examinations was established to boost the quality of medical education by laying down exclusive norms, uniform standards and a national level evaluation for the postgraduate medical courses. The content and context of the training curriculum is well updated as per advances in the field and current requirements. Diplomate of National Board (DNB) courses are considered to be at par with the postgraduate and post doctorate degrees for all intents and purposes. The introduction of a formative assessment with objective evaluation pattern has improved the scope of the board. Moving on to a competency-based training with emphasis on novel research can maximise the quality of training to international standards. Training DNB teachers and assessors in the newer teaching and assessment methods can improve the calibre of residents. Stringent monitoring and review of the training can increase the credibility of the courses and the board can be expected to cater for students abroad.
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Sriram V, Keshri VR, Kumbhar K. The impact of colonial-era policies on health workforce regulation in India: lessons for contemporary reform. HUMAN RESOURCES FOR HEALTH 2021; 19:100. [PMID: 34407831 PMCID: PMC8371885 DOI: 10.1186/s12960-021-00640-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Regulation is a critical function in the governance of health workforces. In many countries, regulatory councils for health professionals guide the development and implementation of health workforce policy, but struggle to perform their responsibilities, particularly in low- and middle-income countries (LMICs). Few studies have analyzed the influence of colonialism on modern-day regulatory policy for health workforces in LMICs. Drawing on the example of regulatory policy from India, the goals of this paper is to uncover and highlight the colonial legacies of persistent challenges in medical education and practice within the country, and provide lessons for regulatory policy in India and other LMICs. MAIN BODY Drawing on peer-reviewed and gray literature, this paper explores the colonial origins of the regulation of medical education and practice in India. We describe three major aspects: (1) Evolution of the structure of the apex regulatory council for doctors-the Medical Council of India (MCI); (2) Reciprocity of medical qualifications between the MCI and the General Medical Council (GMC) in the UK following independence from Britain; (3) Regulatory imbalances between doctors and other cadres, and between biomedicine and Indian systems of medicine. CONCLUSIONS Challenges in medical education and professional regulation remain a major obstacle to improve the availability, retention and quality of health workers in India and many other LMICs. We conclude that the colonial origins of regulatory policy in India provide critical insight into contemporary debates regarding reform. From a policy perspective, we need to carefully interrogate why our existing policies are framed in particular ways, and consider whether that framing continues to suit our needs in the twenty-first century.
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Affiliation(s)
- Veena Sriram
- School of Public Policy and Global Affairs and School of Population and Public Health, University of British Columbia, C. K. Choi Building, 251-1855 West Mall, Vancouver, BC V6T 1Z2 Canada
| | - Vikash R. Keshri
- The George Institute for Global Health, New Delhi, India
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Aftab W, Khan M, Rego S, Chavan N, Rahman-Shepherd A, Sharma I, Wu S, Zeinali Z, Hasan R, Siddiqi S. Variations in regulations to control standards for training and licensing of physicians: a multi-country comparison. HUMAN RESOURCES FOR HEALTH 2021; 19:91. [PMID: 34301245 PMCID: PMC8299694 DOI: 10.1186/s12960-021-00629-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/08/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND To strengthen health systems, the shortage of physicians globally needs to be addressed. However, efforts to increase the numbers of physicians must be balanced with controls on medical education imparted and the professionalism of doctors licensed to practise medicine. METHODS We conducted a multi-country comparison of mandatory regulations and voluntary guidelines to control standards for medical education, clinical training, licensing and re-licensing of doctors. We purposively selected seven case-study countries with differing health systems and income levels: Canada, China, India, Iran, Pakistan, UK and USA. Using an analytical framework to assess regulations at four sequential stages of the medical education to relicensing pathway, we extracted information from: systematically collected scientific and grey literature and online news articles, websites of regulatory bodies in study countries, and standardised input from researchers and medical professionals familiar with rules in the study countries. RESULTS The strictest controls we identified to reduce variations in medical training, licensing and re-licensing of doctors between different medical colleges, and across different regions within a country, include: medical education delivery restricted to public sector institutions; uniform, national examinations for medical college admission and licensing; and standardised national requirements for relicensing linked to demonstration of competence. However, countries analysed used different combinations of controls, balancing the strictness of controls across the four stages. CONCLUSIONS While there is no gold standard model for medical education and practise regulation, examining the combinations of controls used in different countries enables identification of innovations and regulatory approaches to address specific contextual challenges, such as decentralisation of regulations to sub-national bodies or privatisation of medical education. Looking at the full continuum from medical education to licensing is valuable to understand how countries balance the strictness of controls at different stages. Further research is needed to understand how regulating authorities, policy-makers and medical associations can find the right balance of standardisation and context-based flexibility to produce well-rounded physicians.
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Affiliation(s)
| | - Mishal Khan
- Aga Khan University, Karachi, Pakistan.
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, United Kingdom.
| | - Sonia Rego
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, United Kingdom
| | | | - Afifah Rahman-Shepherd
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, United Kingdom
| | | | - Shishi Wu
- National University of Singapore, Singapore, Singapore
| | | | - Rumina Hasan
- Aga Khan University, Karachi, Pakistan
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, United Kingdom
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Mayra K, Padmadas SS, Matthews Z. Challenges and needed reforms in midwifery and nursing regulatory systems in India: Implications for education and practice. PLoS One 2021; 16:e0251331. [PMID: 33989355 PMCID: PMC8121323 DOI: 10.1371/journal.pone.0251331&type=printable] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 04/23/2021] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND In India, nursing regulation is generally weak, midwifery coexists with nursing, and 88% of nursing and midwifery education is provided by the private health sector. The Indian health system faces major challenges for health care provision due to poor quality, indeterminate regulatory functions and lack of reforms. METHODS We undertook a qualitative investigation to understand midwifery and nursing education, and regulatory systems in India, through a review of the regulatory Acts, and an investigation of the perceptions and experiences of senior midwifery and nursing leaders representing administration, advocacy, education, regulation, research and service provision in India with an international perspective. RESULTS There is a lack of importance accorded to midwifery roles within the nursing system. The councils and Acts do not adequately reflect midwifery practice, and remain a barrier to good quality care provision. The lack of required amendment of Acts, lack of representation of midwives and nurses in key governance positions in councils and committees have restrained and undermined leadership positions, which have also impaired the growth of the professions. A lack of opportunities for professional practice and unfair assessment practices are critical concerns affecting the quality of nursing and midwifery education in private institutions across India. Midwifery and nursing students are generally more vulnerable to discrimination and have less opportunities compared to medical students exacerbated by the gender-based challenges. CONCLUSIONS India is on the verge of a major regulatory reform with the National Nursing and Midwifery Commission Bill, 2020 being drafted, which makes this study a crucial and timely contribution. Our findings present the challenges that need to be addressed with regulatory reforms to enable opportunities for direct-entry into the midwifery profession, improving nursing education and practice by empowering midwives and nurses with decision-making powers for nursing and midwifery workforce governance.
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Affiliation(s)
- Kaveri Mayra
- University of Southampton, Southampton, United Kingdom
| | | | - Zoë Matthews
- University of Southampton, Southampton, United Kingdom
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Mayra K, Padmadas SS, Matthews Z. Challenges and needed reforms in midwifery and nursing regulatory systems in India: Implications for education and practice. PLoS One 2021; 16:e0251331. [PMID: 33989355 PMCID: PMC8121323 DOI: 10.1371/journal.pone.0251331] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 04/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In India, nursing regulation is generally weak, midwifery coexists with nursing, and 88% of nursing and midwifery education is provided by the private health sector. The Indian health system faces major challenges for health care provision due to poor quality, indeterminate regulatory functions and lack of reforms. METHODS We undertook a qualitative investigation to understand midwifery and nursing education, and regulatory systems in India, through a review of the regulatory Acts, and an investigation of the perceptions and experiences of senior midwifery and nursing leaders representing administration, advocacy, education, regulation, research and service provision in India with an international perspective. RESULTS There is a lack of importance accorded to midwifery roles within the nursing system. The councils and Acts do not adequately reflect midwifery practice, and remain a barrier to good quality care provision. The lack of required amendment of Acts, lack of representation of midwives and nurses in key governance positions in councils and committees have restrained and undermined leadership positions, which have also impaired the growth of the professions. A lack of opportunities for professional practice and unfair assessment practices are critical concerns affecting the quality of nursing and midwifery education in private institutions across India. Midwifery and nursing students are generally more vulnerable to discrimination and have less opportunities compared to medical students exacerbated by the gender-based challenges. CONCLUSIONS India is on the verge of a major regulatory reform with the National Nursing and Midwifery Commission Bill, 2020 being drafted, which makes this study a crucial and timely contribution. Our findings present the challenges that need to be addressed with regulatory reforms to enable opportunities for direct-entry into the midwifery profession, improving nursing education and practice by empowering midwives and nurses with decision-making powers for nursing and midwifery workforce governance.
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Affiliation(s)
- Kaveri Mayra
- University of Southampton, Southampton, United Kingdom
| | | | - Zoë Matthews
- University of Southampton, Southampton, United Kingdom
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