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Pieterse P, Saracini F. Unsalaried health workers in Sierra Leone: a scoping review of the literature to establish their impact on healthcare delivery. Int J Equity Health 2023; 22:255. [PMID: 38066622 PMCID: PMC10709924 DOI: 10.1186/s12939-023-02066-3] [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: 08/22/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The World Health Organisation (WHO) estimates a 10 million health worker shortage by 2030. Despite this shortage, some low-income African countries paradoxically struggle with health worker surpluses. Technically, these health workers are needed to meet the minimum health worker-population ratio, but insufficient job opportunities in the public and private sector leaves available health workers unemployed. This results in emigration and un- or underemployment, as few countries have policies or plans in place to absorb this excess capacity. Sierra Leone, Liberia and Guinea have taken a different approach; health authorities and/or public hospitals 'recruit' medical and nursing graduates on an unsalaried basis, promising eventual paid public employment. 50% Sierra Leone's health workforce is currently unsalaried. This scoping review examines the existing evidence on Sierra Leone's unsalaried health workers (UHWs) to establish what impact they have on the equitable delivery of care. METHODS A scoping review was conducted using Joanna Briggs Institute guidance. Medline, PubMed, Scopus, Web of Science were searched to identify relevant literature. Grey literature (reports) and Ministry of Health and Sanitation policy documents were also included. RESULTS 36 texts, containing UHW related data, met the inclusion criteria. The findings divide into two categories and nine sub-categories: Charging for care and medicines that should be free; Trust and mistrust; Accountability; Informal provision of care, Private practice and lack of regulation. Over-production of health workers; UHW issues within policy and strategy; Lack of personnel data undermines MoHS planning; Health sector finance. CONCLUSION Sierra Leone's example demonstrates that UHWs undermine equitable access to healthcare, if they resort to employing a range of coping strategies to survive financially, which some do. Their impact is wide ranging and will undermine Sierra Leone's efforts to achieve Universal Health Coverage if unaddressed. These findings are relevant to other LICs with similar health worker surpluses.
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Affiliation(s)
- Pieternella Pieterse
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland.
| | - Federico Saracini
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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Lindenbergh KC, van Duinen AJ, Ahlbäck JG, Kamoh J, Bah S, Ashley T, Löfgren J, Grobusch MP, Sankoh O, Bolkan HA. Prevalence, incidence, repair rate, and morbidity of groin hernias in Sierra Leone: cross-sectional household study. BJS Open 2023; 7:6991921. [PMID: 36655327 PMCID: PMC9849845 DOI: 10.1093/bjsopen/zrac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Knowledge about the prevalence of groin hernias in sub-Saharan Africa is limited. Previous studies have demonstrated a higher incidence of the condition than the annual repair rate. This study aimed to investigate prevalence, incidence, annual repair rate, morbidity, and health-seeking behaviour of persons with groin hernias in Sierra Leone. METHODS This population-based, cross-sectional household survey on groin hernias in Sierra Leone was part of the Prevalence Study on Surgical Conditions 2020 (PRESSCO 2020). Those who indicated possible groin hernia were asked problem-specific questions and underwent physical examination to confirm or exclude the diagnosis. RESULTS 3626 study participants were interviewed. The prevalence of untreated groin hernia was 1.1 per cent (95 per cent c.i. 0.8 to 1.5 per cent), whereas the prevalence of untreated and treated groin hernia was 2.5 per cent (95 per cent c.i. 2.0 to 3.0 per cent). The proportion of recurrence was 13.1 per cent. An incidence of 389 (95 per cent c.i. 213 to 652) groin hernia cases per 100 000 people per year was identified, while a population-based annual hernia repair rate estimation was 470 (95 per cent c.i. 350 to 620) per 100 000 people. Out of 39 participants with groin hernia, non-ignorable pain was reported by eight and 27 reported financial shortcomings as a reason for not seeking healthcare. CONCLUSIONS Groin hernias are common in Sierra Leone and although the repair rate might match the incidence, the existing backlog of untreated hernias is likely to remain. It may be possible to reduce the number of recurrences through improved management. Measures to reduce financial barriers to treatment seem crucial to improve the health of people with groin hernias in Sierra Leone.
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Affiliation(s)
| | - Alex J van Duinen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway,Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway,CapaCare, Norway, Sierra Leone, The Netherlands
| | - Johan G Ahlbäck
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Silleh Bah
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
| | - Thomas Ashley
- CapaCare, Norway, Sierra Leone, The Netherlands,Kamakwie Wesleyan Hospital, Kamakwie, Sierra Leone
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Martin P Grobusch
- Masanga Medical Research Unit, Masanga, Sierra Leone,Centre of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands,Institute of Tropical Medicine, University of Tubingen, Tubingen, Germany,Centre de Recherches Medicales en Lambarene (CERMEL), Lambarene, Gabon,Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Osman Sankoh
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone,School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa,Heidelberg Institute of Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - Håkon A Bolkan
- Correspondence to: Håkon A. Bolkan, MD PhD, Norwegian University of Science and Technology, Postboks 8900, Torgarden, 7491 Trondheim, Norway (e-mail: )
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Huang Y, Mustapha J, Harrison-Williams L, Fashina T, Randleman C, Ifantides C, Shantha JG, Yeh S. Global Ophthalmic Health Initiatives in Ebola and Emerging Infectious Disease Outbreaks: Implications for Vision Health Systems, Program Implementation, and Disease Surveillance. Int Ophthalmol Clin 2023; 63:79-89. [PMID: 36598835 PMCID: PMC9819215 DOI: 10.1097/iio.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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