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Bhattacharjya S, Curtis S, Kueakomoldej S, von Zweck C, Russo G, Mani K, Kamalakannan S, Ledgerd R, Jesus TS. Developing a Global Strategy for strengthening the occupational therapy workforce: a two-phased mixed-methods consultation of country representatives shows the need for clarifying task-sharing strategies. HUMAN RESOURCES FOR HEALTH 2024; 22:62. [PMID: 39237995 PMCID: PMC11375928 DOI: 10.1186/s12960-024-00948-3] [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: 09/19/2023] [Accepted: 08/27/2024] [Indexed: 09/07/2024]
Abstract
INTRODUCTION Occupational therapy has been underdeveloped and often neglected in the global health workforce agenda, contrasting with the global rise of population needs for services. The World Federation of Occupational Therapists (WFOT) is utilizing a research-based, multi-step process for developing a Global Strategy for strengthening the occupational therapist workforce. A multi-pronged scoping review, situational analysis, and expert input process enabled the drafting of a provisional Global Strategy. Here, feedback on that draft from representatives of WFOT member organizations was obtained and analyzed as one key intermediate step toward shaping the in-developing Strategy's content and structure. METHODS Two-phased, mixed-methods consultation consisting of: (1) online survey with score ratings and comments on the utility of each strategy and (2) four in-person focus groups discussions on low-scoring items involving a total of 76 representatives of WFOT member organizations. The focus group discussions were analyzed using an inductive thematic analysis approach. RESULTS Strategies involving 'task shifting/task sharing' or the 'harmonization of workforce data-collection requirements' received the lowest scores in the initial survey and were thereby addressed in the focus groups discussions. The overarching theme of the focus groups was the need to: "clarify, specify, and contextualize the strategies", including: (1) "clarify the terminology and specify the application", for example, describe the meaning of task shifting, specify which tasks can (and cannot) be shifted and to whom, to address concerns regarding scope-of-practice, service demand, and safety; and (2) "outline the context of need and the context for the implementation" of the strategies, elucidating why the strategies are needed and how they can be feasibly implemented across the different jurisdictional contexts. CONCLUSION Within a mixed-methods consultation, WFOT representatives identified challenging topics on the draft workforce strategies and suggested methods to improve the Global Strategy, its acceptability, and implementation. The terms 'task shifting/task sharing' raised the greatest discussion among the profession leaders, when the strategy was not sufficiently clarified, specified, or contextualized.
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Affiliation(s)
| | - Sarah Curtis
- Department of Occupational Therapy, Georgia State University, Atlanta, GA, USA
| | - Supakorn Kueakomoldej
- Center for Education in Health Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Giuliano Russo
- Wolfson Institute of Population Health, Queen Mary University, London, UK
| | - Karthik Mani
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX, USA
| | - Sureshkumar Kamalakannan
- Department of Social Work, Education and Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Ritchard Ledgerd
- World Federation of Occupational Therapists, Geneva, Switzerland
| | - Tiago S Jesus
- Division of Occupational Therapy, School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Gideon J, Asthana S, Bisht R. Health systems in India: analysing barriers to inclusive health leadership through a gender lens. BMJ 2024; 386:e078351. [PMID: 39019544 PMCID: PMC11249731 DOI: 10.1136/bmj-2023-078351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Affiliation(s)
- Jasmine Gideon
- Birkbeck, University of London, London, UK
- Global Health 5050, Cambridge, UK
| | - Sumegha Asthana
- Centre for Global Health Science and Security, Georgetown University, Washington DC, USA
| | - Ramila Bisht
- Centre for Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
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Alayande BT, Forbes C, Kingpriest P, Adejumo A, Williams W, Wina F, Agbo CA, Omolabake B, Bekele A, Ismaila BO, Kerray F, Sule A, Abahuje E, Robertson JM, Yule S, Riviello R, Isichei M. Non-technical skills training for Nigerian interprofessional surgical teams: a cross-sectional survey. BMC MEDICAL EDUCATION 2024; 24:547. [PMID: 38755653 PMCID: PMC11097506 DOI: 10.1186/s12909-024-05550-8] [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: 02/02/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Non-technical skills (NTS) including communication, teamwork, leadership, situational awareness, and decision making, are essential for enhancing surgical safety. Often perceived as tangential soft skills, NTS are many times not included in formal medical education curricula or continuing medical professional development. We aimed to explore exposure of interprofessional teams in North-Central Nigeria to NTS and ascertain perceived facilitators and barriers to interprofessional training in these skills to enhance surgical safety and inform design of a relevant contextualized curriculum. METHODS Six health facilities characterised by high surgical volumes in Nigeria's North-Central geopolitical zone were purposively identified. Federal, state, and private university teaching hospitals, non-teaching public and private hospitals, and a not-for-profit health facility were included. A nineteen-item, web-based, cross-sectional survey was distributed to 71 surgical providers, operating room nurses, and anaesthesia providers by snowball sampling through interprofessional surgical team leads from August to November 2021. Data were analysed using Fisher's exact test, proportions, and constant comparative methods for free text responses. RESULTS Respondents included 17 anaesthesia providers, 21 perioperative nurses, and 29 surgeons and surgical trainees, with a 95.7% survey completion rate. Over 96% had never heard of any NTS for surgery framework useful for variable resource contexts and only 8% had ever received any form of NTS training. Interprofessional teams identified communication and teamwork as the most deficient personal skills (38, 57%), and as the most needed for surgical team improvement (45, 67%). There was a very high demand for NTS training by all surgical team members (64, 96%). The main motivations for training were expectations of resultant improved patient safety and improved interprofessional team dynamics. Week-long, hybrid training courses (with combined in-person and online components) were the preferred format for delivery of NTS education. Factors that would facilitate attendance included a desire for patient safety and self-improvement, while barriers to attendance were conflicts of time, and training costs. CONCLUSIONS Interprofessional surgical teams in the Nigerian context have a high degree of interest in NTS training, and believe it can improve team dynamics, personal performance, and ultimately patient safety. Implementation of NTS training programs should emphasize interprofessional communication and teamworking.
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Affiliation(s)
- Barnabas Tobi Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda.
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria.
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America.
- Surgical Equity Research Hub, Jos, Nigeria.
| | - Callum Forbes
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
| | | | | | - Wendy Williams
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Felix Wina
- Department of Surgery, Bingham University Teaching Hospital, Jos, Nigeria
| | - Christian Agbo Agbo
- Department of Surgery, Benue State University Teaching Hospital, Markudi, Nigeria
| | - Bamidele Omolabake
- Department of Surgery, Benue State University Teaching Hospital, Markudi, Nigeria
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Bashiru O Ismaila
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Fiona Kerray
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | - Augustine Sule
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Egide Abahuje
- University of Rwanda, Kigali, Rwanda
- Department of Surgery, Northwestern University, Evanston, Ilinois, United States of America
| | - Jamie M Robertson
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Steven Yule
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | - Robert Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Mercy Isichei
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
- The Faith Alive Foundation, Jos, Nigeria
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Yarhere IE, Ogundipe O, Williams A, Farouk AG, Raji Y, Makanjuola V, N Adeboye MA. Scaling up numbers and competency of graduating medical and dental students in Nigeria: Need to improve medical trainers' competency in teaching. Niger J Clin Pract 2023; 26:1377-1382. [PMID: 37794553 DOI: 10.4103/njcp.njcp_246_23] [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] [Indexed: 10/06/2023]
Abstract
Background With the increasing medical brain drain in Nigeria, there is a need to train and graduate more doctors to fill in the gaps created to mitigate the effects. To meet this goal, the trainers need to evolve and have the competency to deliver quality training for many more enrollees in medical schools. Aim This study aimed to gather information about the perception of medical teachers' need to obtain certification in medical education and what this will achieve in scaling up the competency and number of graduating medical doctors. Subjects and Methods Medical teachers in Nigeria participated in this mixed (quantitative and qualitative) study. Four hundred medical consultants and teachers were randomly selected and sent a semi-structured pre-validated questionnaire; also, a panel discussion was conducted with six medical teachers with other special assignments in universities and postgraduate colleges. Quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) 24, differences in proportions were calculated using the Chi-square test, and P values <0.05 were considered significant. Results Two hundred and thirty-eight (59.5%) participants completed the form, 63 (26.5%) had practiced for <5 years, and 114 (47.9%) had >10 years of practice experience. A majority of 168 (70.6%) were physician lecturers in federal or state universities, and 15.5% had obtained certifications of any kind in medical education. Over 80% perceived that medical education training should not be a prerequisite to teach, but a similar percentage believed that faculty medical education training can help scale up the training competency and the number of graduating medical doctors. Conclusion To scale up the number and competency of graduating medical doctors, medical teachers need to acquire core teaching competency. The respondents and discussants believe that when these core teaching competencies have been fully developed, it will be easier to increase the number of medical students' enrollees, teach them their curriculum through innovations, and graduate them with improved competencies.
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Affiliation(s)
- I E Yarhere
- Department of Paediatrics, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - O Ogundipe
- Department of oral and Maxillofacial Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - A Williams
- Department of Anaesthesia, Federal Medical Centre, Lokoja, Kogi, Nigeria
| | - A G Farouk
- Department of Paediatrics, University of Maiduguri, Maiduguri, Borno, Turkey
| | - Y Raji
- Department of Internal Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - V Makanjuola
- Department of Paediatrics, University of Ilorin, Kwara State, Nigeria
| | - M A N Adeboye
- Department of Psychiatry, University of Ibadan, Ibadan, Oyo, Nigeria
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Kapilashrami A. Situating Biomedical and Professional Monopoly at the Intersections of Structural, Ideational and Agentic Power Comment on "Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process". Int J Health Policy Manag 2023; 12:8019. [PMID: 37579361 PMCID: PMC10702371 DOI: 10.34172/ijhpm.2023.8019] [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: 03/10/2023] [Accepted: 06/12/2023] [Indexed: 08/16/2023] Open
Abstract
Lassa and colleagues' study is a strong commentary on the biomedical hegemony and professional monopoly of medical doctors in the policy landscape of the Global Fund in Nigeria. Situating this critical dimension of professional power within wider scholarship of power and governance of global health initiatives (such as the Global Fund), in this comment, I put forth two core arguments. I call for a relational perspective of power in a dynamic policy space that the Fund characterises. I argue that a systems-view analysis of power requires a thorough examination of subsystems, how they interact, and the diverse forms of power-individual agentic, ideational, and structural-and the mechanisms through which power is wielded. The lens of governmentality allows linking individual (expertise and practices) with institutional regimes and social practices these enable; and in examining the interface of local/ sub-national, national, and global within which policy formulation and implementation occurs.
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Adigwe OP, Mohammed ENA, Onavbavba G. Preventing and Mitigating Inter-Professional Conflict Among Healthcare Professionals in Nigeria. J Healthc Leadersh 2023; 15:1-9. [PMID: 36636738 PMCID: PMC9831122 DOI: 10.2147/jhl.s392882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction The primary obligation of healthcare professionals is the well-being of patients. Inter-professional conflict can prevent the achievement of this goal, thereby potentially putting patients in peril. This study aimed at articulating contextual strategies to mitigate and prevent inter-professional conflict among healthcare workers in Nigeria. Methods A cross sectional study was undertaken in various health facilities in Nigeria. Questionnaires were administered to healthcare professionals. Completed questionnaires were analysed using Statistical Package for Social Sciences. Descriptive and inferential statistical analyses were undertaken. Results A total of 2207 valid responses were included for analysis. Findings revealed that almost all the respondents (92.9%) indicated that the Ministry of Health has a key role in resolving conflict in the healthcare sector. Close to three quarters (70.4%) of the study participants disagreed that leadership of hospitals and health agencies be limited to a particular profession. Almost all the participants (90.15%) indicated that cognate administrative expertise and experience are critical for leadership. A strong majority of the sample (93.5%) opined that reforms are required in the leadership selection process of hospital and other healthcare agencies. Conclusion Due to the criticality of this issue to patients' access to healthcare, findings from this study can underpin a proactive evidence based strategy that can comprehensively address inter-professional conflict among healthcare workers in Nigeria.
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Affiliation(s)
- Obi Peter Adigwe
- Office of the Director General, National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria,Correspondence: Obi Peter Adigwe, Office of the Director General, National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria, Email
| | - Elijah N A Mohammed
- Office of the Registrar, Pharmacists Council of Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Godspower Onavbavba
- Office of the Director General, National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria
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Mohammed ENA, Onavbavba G, Wilson DOM, Adigwe OP. Understanding the Nature and Sources of Conflict Among Healthcare Professionals in Nigeria: A Qualitative Study. J Multidiscip Healthc 2022; 15:1979-1995. [PMID: 36101553 PMCID: PMC9464442 DOI: 10.2147/jmdh.s374201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Inter-professional conflict in the Nigerian health sector is a concept that is as old as modern medical practice and has resulted in disruption of health care delivery, with the overall impact bearing down on patients. Purpose This study aimed to provide an in-depth understanding and a clearer insight into the causes of conflict in the Nigerian health sector. Methods A qualitative strategy was employed using a semi-structured interview approach. Data were obtained from health practitioners from diverse backgrounds in various healthcare facilities. Results The phenomenon of conflict was reported as a long existent and trans-generational strain on inter-professional relationships occurring in all sectors of health practice, primarily between the physicians and other health care professionals. Inter-professional conflict was reported to emanate primarily from lapses in leadership, remuneration structure, role description, communication and emotional intelligence. This has affected the effectiveness of the Nigerian healthcare system and has contributed to hindrance in the provision of high-quality care in the country. Conclusion Evidence from this study can help in developing contextual policy in addressing inter-professional conflict in the health sector, and this will consequently improve health care delivery in the country.
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Affiliation(s)
- Elijah N A Mohammed
- Office of the Registrar, Pharmacists Council of Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Godspower Onavbavba
- Office of the Director General, National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria
| | - Diana Oyin-Mieyebi Wilson
- Office of the Director General, National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria
| | - Obi Peter Adigwe
- Office of the Director General, National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria
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Igwesi-Chidobe CN, Anyaene C, Akinfeleye A, Anikwe E, Gosselink R. Experiences of physiotherapists involved in front-line management of patients with COVID-19 in Nigeria: a qualitative study. BMJ Open 2022; 12:e060012. [PMID: 35487524 PMCID: PMC9051550 DOI: 10.1136/bmjopen-2021-060012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Evidence-based guidelines recommend physiotherapy for respiratory treatment and physical rehabilitation of patients with COVID-19. It is unclear to what extent physiotherapy services are used in the front-line management of COVID-19 in Nigeria. This study aimed to explore the experiences of front-line physiotherapists managing patients with COVID-19 in Nigeria. DESIGN Qualitative interview-based study. SETTING ICU and hospital COVID-19 wards, COVID-isolation and treatment centres in Nigeria, between August 2020 and January 2021. PARTICIPANTS Eight out of 20 physiotherapists managing patients with COVID-19 in the front line were recruited using purposive and snowball sampling. METHODS Qualitative in-depth semistructured telephone interviews of all consenting physiotherapists managing patients with COVID-19 in the front line in Nigeria were conducted and transcribed verbatim. Transcripts were thematically analysed. RESULTS Eight front-line physiotherapists (three neurological physiotherapists, two orthopaedic physiotherapists, one cardiopulmonary physiotherapist, one sports physiotherapist and one rotational physiotherapist) provided consent and data for this study. Four themes and 13 subthemes were generated illustrating discriminatory experiences of front-line physiotherapists, particularly from COVID-19 team leads; lack of multidisciplinary teamwork within COVID-19 teams; wide ranging stigmatisation from extended family members, colleagues, friends and the general public; material and psychosocial personal losses; lack of system support and suboptimal utilisation of physiotherapy in the management of COVID-19 in Nigeria. Personal agency, sense of professionalism, previous experience managing highly infectious diseases and being a cardiopulmonary physiotherapist were the factors that made the front-line physiotherapists to become involved in managing patients with COVID-19. However, discriminatory experiences made some of these physiotherapists to stop being involved in the management of patients with COVID-19 in the front line. Most front-line physiotherapists were not cardiopulmonary physiotherapists which may have influenced their level of expertise, multidisciplinary involvement and patient outcomes. CONCLUSIONS There is suboptimal involvement and support for physiotherapists, particularly cardiopulmonary physiotherapists treating patients with COVID-19 in the front line in Nigeria.
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Affiliation(s)
- Chinonso N Igwesi-Chidobe
- Department of Medical Rehabilitation, University of Nigeria, Nsukka, Nigeria
- Global Population Health Research Group, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chiamaka Anyaene
- Department of Medical Rehabilitation, University of Nigeria, Nsukka, Nigeria
| | - Adegoke Akinfeleye
- Department of Physiotherapy, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Ernest Anikwe
- Department of Physiotherapy, University College Hospital, Ibadan, Oyo, Nigeria
| | - Rik Gosselink
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
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Hu WCY, Nguyen VAT, Nguyen NT, Stalmeijer RE. Becoming Agents of Change: Contextual Influences on Medical Educator Professionalization and Practice in a LMIC Context. TEACHING AND LEARNING IN MEDICINE 2022:1-12. [PMID: 35465797 DOI: 10.1080/10401334.2022.2056743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
Medical educators are particularly needed in Low- and Middle-Income Countries (LMIC), where medical schools have grown rapidly in size, number, and global outlook in response to persistent health workforce shortages and increased expectations of quality care. Educator development is thus the focus of many LMIC programs initiated by universities and governments of high income countries. While signs of medical educator professionalization such as postgraduate qualifications, specialized units, and professional associations have emerged in LMIC, whether these relate to programs originating from outside LMIC contexts is unknown. This study investigated the contextual influences on the long-term impact of an international faculty development program a decade after its delivery in a LMIC context - Vietnam. Ten years after an international aid program to develop clinical skills teaching expertise in Vietnam, we conducted in-depth qualitative interviews with eight medical educators from all eight participating medical schools. Selected for their leadership potential, each participant had completed the Maastricht Masters in Health Professions Education during the program. Interview transcripts underwent thematic analysis, using the Theory of Practice Architectures as a conceptual lens to highlight the contextual influences on professional practice. Four themes were identified: Careers and Practices before, during, and after the program, Unrecognized and Unseen practice, Structural Restraints on individual advancement and collective activity, and the Cultivation of Connections through social traditions. Participants reported being in well-established teaching delivery roles. However, the absence of professionalizing discourses and material resources meant that practice was restricted and determined by institutional leadership and individuals' adaptations. Informed by the theory of practice architectures, we found that change in medical education practice will falter in contexts that lack supporting discursive, material-economic, and socio-political arrangements. While there were emerging signs of individual agency, the momentum of change was not sustained and perhaps unapparent to Western framings of educational leadership. Practice architectures offers a framework for identifying the contextual features which influence practice, from which to design and deliver sustainable and impactful interventions, and to advance context-relevant evaluation and research. Our findings suggest that faculty development delivered across diverse contexts, such as in distributed or transnational medical programs, may have more effect if informed by a practice architectures analysis of each context.
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Affiliation(s)
- Wendy Chung-Ya Hu
- Medical Education Unit, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Van Anh Thi Nguyen
- Department of Medical Education and Skills Laboratory, Hanoi Medical University, Hanoi, Vietnam
| | - Nga Thanh Nguyen
- Learning Futures, Western Sydney University, Parramatta, Australia
| | - Renée E Stalmeijer
- Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, Adetifa IMO, Colbourn T, Ogunlesi AO, Onwujekwe O, Owoaje ET, Okeke IN, Adeyemo A, Aliyu G, Aliyu MH, Aliyu SH, Ameh EA, Archibong B, Ezeh A, Gadanya MA, Ihekweazu C, Ihekweazu V, Iliyasu Z, Kwaku Chiroma A, Mabayoje DA, Nasir Sambo M, Obaro S, Yinka-Ogunleye A, Okonofua F, Oni T, Onyimadu O, Pate MA, Salako BL, Shuaib F, Tsiga-Ahmed F, Zanna FH. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet 2022; 399:1155-1200. [PMID: 35303470 PMCID: PMC8943278 DOI: 10.1016/s0140-6736(21)02488-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Blake Angell
- UCL Institute for Global Health, London, UK; The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Olutobi Sanuade
- UCL Institute for Global Health, London, UK; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Aishatu Lawal Adamu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ifedayo M O Adetifa
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Eme T Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sani Hussaini Aliyu
- Infectious Disease and Microbiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Belinda Archibong
- Department of Economics, Barnard College, Columbia University, New York, NY, USA
| | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | | | | | - Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Aminatu Kwaku Chiroma
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Diana A Mabayoje
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Stephen Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA; International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | | | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria; University of Medical Sciences, Ondo City, Nigeria
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Research Initiative for Cities Health and Equity, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Muhammad Ali Pate
- Health, Nutrition and Population (HNP) Global Practice and Global Financing Facility for Women, Children and Adolescents, World Bank, Washington DC, WA, USA; Harvard T Chan School of Public Health, Boston, MA, USA
| | | | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Fatimah Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
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Belrhiti Z, Van Belle S, Criel B. How medical dominance and interprofessional conflicts undermine patient-centred care in hospitals: historical analysis and multiple embedded case study in Morocco. BMJ Glob Health 2021; 6:bmjgh-2021-006140. [PMID: 34261759 PMCID: PMC8280911 DOI: 10.1136/bmjgh-2021-006140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background In Morocco’s health systems, reforms were accompanied by increased tensions among doctors, nurses and health managers, poor interprofessional collaboration and counterproductive power struggles. However, little attention has focused on the processes underlying these interprofessional conflicts and their nature. Here, we explored the perspective of health workers and managers in four Moroccan hospitals. Methods We adopted a multiple embedded case study design and conducted 68 interviews, 8 focus group discussions and 11 group discussions with doctors, nurses, administrators and health managers at different organisational levels. We analysed what health workers (doctors and nurses) and health managers said about their sources of power, perceived roles and relationships with other healthcare professions. For our iterative qualitative data analysis, we coded all data sources using NVivo V.11 software and carried out thematic analysis using the concepts of ‘negotiated order’ and the four worldviews. For context, we used historical analysis to trace the development of medical and nursing professions during the colonial and postcolonial eras in Morocco. Results Our findings highlight professional hierarchies that counterbalance the power of formal hierarchies. Interprofessional interactions in Moroccan hospitals are marked by conflicts, power struggles and daily negotiated orders that may not serve the best interests of patients. The results confirm the dominance of medical specialists occupying the top of the professional hierarchy pyramid, as perceived at all levels in the four hospitals. In addition, health managers, lacking institutional backing, resources and decision spaces, often must rely on soft power when dealing with health workers to ensure smooth collaboration in care. Conclusion The stratified order of care professions creates hierarchical professional boundaries in Moroccan hospitals, leading to partitioning of care and poor interprofessional collaboration. More attention should be placed on empowering health workers in delivering quality care by ensuring smooth interprofessional collaboration.
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Affiliation(s)
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart Criel
- Unit of Equity and Health, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Mishra A, Elias MA, Sriram V. A Draconian Law: Examining the Navigation of Coalition Politics and Policy Reform by Health Provider Associations in Karnataka, India. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2021; 46:703-730. [PMID: 33493290 DOI: 10.1215/03616878-8970895] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A comprehensive picture of provider coalitions in health policy making remains incomplete because of the lack of empirically driven insights from low- and middle-income countries. The authors examined the politics of provider coalitions in the health sector in Karnataka, India, by investigating policy processes between 2016 and 2018 for developing amendments to the Karnataka Private Medical Establishments Act. Through this case, they explore how provider associations function, coalesce, and compete and the implications of their actions on policy outcomes. They conducted in-depth interviews, document analysis, and nonparticipant observations of two conferences organized by associations. They found that provider associations played a major role in drafting the amendments and negotiating competing interests within and between doctors and hospital associations. Despite the fragmentation, the associations came together to reinterpret the intentions of the amendments as being against the interests of the profession, culminating in a statewide protest and strike. Despite this show of strength, provider associations only secured modest modifications. This case demonstrates the complex and unpredictable influence of provider associations in health policy processes in India. The authors' analysis highlights the importance of further empirical study on the influence of professional and trade associations across a range of health policy cases in low- and middle-income countries.
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