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Schaefle KJ, Habimana A, Mhoza G, Musominali S. Clinical officers in Uganda: Training and workforce role. JAAPA 2024; 37:1-6. [PMID: 38916374 DOI: 10.1097/01.jaa.0000000000000027] [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: 06/26/2024]
Abstract
ABSTRACT The clinical role of a clinical officer in Uganda is very similar to that of a physician associate/assistant in the United States. This article describes the qualifications and workforce role of clinical officers in Uganda, as well as their use in two primary care programs that provide effective, low-cost medical care to a growing population with an increasing burden of chronic disease.
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Affiliation(s)
- Kenneth J Schaefle
- Kenneth J. Schaefle is an assistant professor of medicine at the Albert Einstein College of Medicine and Montefiore Medical Center in New York, N.Y. He has been going to the Kisoro District of southwest Uganda regularly for 10 years. Aloyse Habimana is a clinical officer with Doctors for Global Health in Kisoro. Gideon Mhoza is a student in the clinical officers program at Kabale Institute of Health Sciences. Sam Musominali is the village health worker program director for Doctors for Global Health. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Buthelezi S, Gerber B. Cultural Competence in Ophthalmic Dispensing Education: A Qualitative Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:585-594. [PMID: 38915926 PMCID: PMC11195680 DOI: 10.2147/amep.s438707] [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: 09/25/2023] [Accepted: 12/13/2023] [Indexed: 06/26/2024]
Abstract
Purpose Understanding and acknowledging cultural diversity in healthcare is essential in providing culturally competent care. Higher education institutions are critical to providing students with the necessary knowledge, attitudes, and skills to respond to cultural diversity in various contexts. Cultural competence teaching in ophthalmic dispensing education has emerged as an essential concept that needs to be included in the curriculum. This study explored ophthalmic dispensing lecturers' understandings, experiences, and attitudes in teaching cultural competence. Methods This study used a qualitative approach within an interpretivist paradigm by conducting semi-structured interviews with lecturers (n = 7) in the ophthalmic dispensing program. Braun and Clarke's framework for thematic analysis was utilized. The research was conducted at an ophthalmic dispensing department at a South African university. Results The analysis of the semi-structured interviews indicated three main themes of importance regarding factors influencing cultural competence education in the ophthalmic dispensing curriculum: the interplay between experiences and understandings of cultural competence, cross-cultural exposure and teaching practices, and inclusion of cultural competence into the curriculum. The participants recognized that cultural competence was not explicitly included in the curriculum. Including culture in education was rather unsystematic and, in most cases, unplanned. Conclusion Further training of lecturers on cultural competence skills and evidence-based teaching and assessment strategies are required to assist in developing curricula that include cultural competence.
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Affiliation(s)
- Sanele Buthelezi
- Department of Optometry, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
- Department of Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Berna Gerber
- Division of Speech-Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Cape Town, South Africa
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Dymmott A, George S, Campbell N, Brebner C. Sustaining our rural allied health workforce: experiences and impacts of the allied health rural generalist pathway. BMC Health Serv Res 2024; 24:749. [PMID: 38898443 PMCID: PMC11186235 DOI: 10.1186/s12913-024-11207-5] [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: 11/08/2023] [Accepted: 06/14/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Rural and remote communities face significant disadvantages accessing health services and have a high risk of poor health outcomes. Workforce challenges in these areas are multifaceted, with allied health professionals requiring broad skills and knowledge to provide vital services to local communities. To develop the expertise for rural and remote practice, the allied health rural generalist pathway (AHRGP) was introduced to develop and recognise specialist skills and knowledge required for rural and remote practice, however the experiences of professionals has not been explored. This study gained the experiences and perceptions of allied health professionals undertaking the pathway as well as their clinical supervisors, line managers, profession leads and consumer representatives. METHODS A qualitative study was undertaken drawing on pragmatic approaches across four research phases. This study was one component of a larger mixed methods study investigating the experience, impact and outcomes of the AHRGP across six regional Local Health Networks in South Australia (SA). Interviews, surveys and focus groups were conducted to explore the perceptions and experiences of participants. Data was analysed thematically across participant groups and research phases. RESULTS A total of 54 participants including 15 trainees, 13 line managers, nine clinical supervisors, six profession leads, four program managers and seven consumer representatives informed this study. Five themes were generated from the data; gaining broad skills and knowledge for rural practice, finding the time to manage the pathway, implementing learning into practice, the AHRGP impacts the whole team and confident, consistent, skilled allied health professionals positively impact consumers. CONCLUSION The AHRGP is offering allied health professionals the opportunity to develop skills and knowledge for rural and remote practice. It is also having positive impacts on individuals' ability to manage complexity and solve problems. Findings indicated consumers and organisations benefited through the provision of more accessible, consistent, and high quality services provided by trainees. Trainees faced challenges finding the time to manage study and to implement learning into practice. Organisations would benefit from clearer support structures and resourcing to support the pathway into the future. Incentives and career advancement opportunities for graduates would strengthen the overall value of the AHRPG.
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Affiliation(s)
- Alison Dymmott
- College of Nursing and Health Sciences, Flinders University Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia.
| | - Stacey George
- College of Nursing and Health Sciences, Flinders University Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Narelle Campbell
- College of Medicine and Public Health, Flinders University Northern Territory, Flinders University, Darwin, NT, Australia
| | - Chris Brebner
- College of Nursing and Health Sciences, Flinders University Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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Gallagher JE, Mattos Savage GC, Crummey SC, Sabbah W, Makino Y, Varenne B. Health workforce for oral health inequity: Opportunity for action. PLoS One 2024; 19:e0292549. [PMID: 38870162 PMCID: PMC11175420 DOI: 10.1371/journal.pone.0292549] [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: 12/23/2022] [Accepted: 09/24/2023] [Indexed: 06/15/2024] Open
Abstract
Oral health is high on the global agenda following the adoption of the 2022 global strategy on oral health at the 75th World Health Assembly. Given the global burden of oral disease, workforce development to achieve universal health coverage [UHC] is crucial to respond to population needs within the non-communicable disease agenda. The aim of this paper is to present an overview of the oral health workforce [OHWF] globally in relation to key contextual factors. Data from the National Health Workforce Accounts and a survey of World Health Organization [WHO] member states were integrated for analysis, together with country-level data on population and income status. Data are presented using the WHO categorisation of global regions and income status categories established by the World Bank. Workforce densities for key OHWF categories were examined. Multiple regression was used to model workforce density and contextual influences. Challenges and possible solutions were examined by country income status. There are approximately 3.30 dentists per 10,000 population globally, and a combined OHWF [dentists, dental assistants/therapists and dental prosthetic technicians] of 5.31 per 10,000. Marked regional inequalities are evident, most notably between WHO European and African regions; yet both make greater use of skill mix than other regions. When adjusted by region, 'country income status' and 'population urbanization' are strong predictors of the workforce density of dentists and even more so for the combined OHWF. Maldistribution of the workforce [urban/rural] was considered a particular workforce challenge globally and especially for lower-income countries. Strengthening oral health policy was considered most important for the future. The global distribution of dentists, and the OHWF generally, is inequitable, with variable and limited use of skill mix. Creative workforce development is required to achieve the global oral health agenda and work towards equity using innovative models of care, supported by effective governance and integrated policies.
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Affiliation(s)
- Jennifer E. Gallagher
- Dental Public Health, Centre for Host Microbiome Interactions, King’s College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Denmark Hill Campus, London, United Kingdom
| | - Grazielle C. Mattos Savage
- Dental Public Health, Centre for Host Microbiome Interactions, King’s College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Denmark Hill Campus, London, United Kingdom
| | - Sarah C. Crummey
- Dental Public Health, Centre for Host Microbiome Interactions, King’s College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Denmark Hill Campus, London, United Kingdom
| | - Wael Sabbah
- Dental Public Health, Centre for Host Microbiome Interactions, King’s College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Denmark Hill Campus, London, United Kingdom
| | - Yuka Makino
- Noncommunicable Diseases Management Team, WHO Regional Office for Africa, Cité Djoué, Brazzaville, Congo
| | - Benoit Varenne
- WHO Oral Health Programme, Noncommunicable Diseases Department | Division of Universal Health Coverage & Communicable and Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Somerville JG, Strang NC, Jonuscheit S. Task-shifting and the recruitment and retention of eye care workers in under-served areas: a qualitative study of optometrists' motivation in Ghana and Scotland. Prim Health Care Res Dev 2024; 25:e30. [PMID: 38818764 DOI: 10.1017/s1463423624000185] [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: 06/01/2024] Open
Abstract
AIM To assist policy-makers in improving access to eye care in under-served areas by analysing the relationship between motivational factors affecting the uptake of task-shifting in eye care and the recruitment and retention of optometrists in remote and rural areas. BACKGROUND The World Health Organization recommends two key strategies in tackling preventable blindness in under-served areas: improving human resources for health and task-shifting. The relationship between task-shifting and recruitment and retention of eye care workers in under-served areas is unknown. Ghana and Scotland are two countries from different levels of economic development that have notably expanded the roles of optometrists and struggle with rural recruitment and retention. METHODS Motivation was explored through semi-structured interviews with 19 optometrists in Ghana and Scotland with experience in remote and rural practice. Framework analysis was used to analyse interviews, explore the relationship between task-shifting and recruitment and retention and create recommendations for policy. FINDINGS The main motivational considerations included altruism, quality of life, learning and career opportunities, fulfilling potential, remuneration, stress of decision-making and collaboration. Motivational and demotivational factors for task-shifting and recruitment/retention shared many similar aspects. DISCUSSION Recruitment and retention in remote and rural areas require staff be incentivised to take up those positions, motivated to remain and given the adequate resources for personal and professional fulfilment. Task-shifting also requires incentivisation, motivation to continue and the resources to be productive. Many motivational factors influencing recruitment/retention and task-shifting are similar suggesting these two strategies can be compatible and complementary in improving access to eye care, although some factors are culture and context specific. Understanding optometrists' motivation can help policy-makers improve rural recruitment and retention and plan services.
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Affiliation(s)
- Joel G Somerville
- Glasgow Caledonian University, Glasgow, UK
- University of the Highlands and Islands, Inverness, UK
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Xu X, Huang J, Zhao X, Luo Y, Wang L, Ge Y, Yu X, Zhu P. Trends in the mobility of primary healthcare human resources in underdeveloped regions of western China from 2000 to 2021: Evidence from Nanning. BMC PRIMARY CARE 2024; 25:154. [PMID: 38711072 PMCID: PMC11071274 DOI: 10.1186/s12875-024-02403-7] [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: 12/06/2023] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE This research aimed to identify the fundamental and geographic characteristics of the primary healthcare personnel mobility in Nanning from 2000 to 2021 and clarify the determinants that affect their transition to non-primary healthcare institutions. METHODS Through utilizing the Primary Healthcare Personnel Database (PHPD) for 2000-2021, the study conducts descriptive statistical analysis on demographic, economic, and professional aspects of healthcare personnel mobility across healthcare reform phases. Geographic Information Systems (QGIS) were used to map mobility patterns, and R software was employed to calculate spatial autocorrelation (Moran's I). Logistic regression identified factors that influenced the transition to non-primary institutions. RESULTS Primary healthcare personnel mobility is divided into four phases: initial (2000-2008), turning point (2009-2011), rapid development (2012-2020), and decline (2021). The rapid development stage saw increased mobility with no spatial clustering in inflow and outflow. From 2016 to 2020, primary healthcare worker mobility reached its peak, in which the most significant movement occurred between township health centers and other institutions. Aside from their transition to primary medical institutions, the primary movement of grassroots health personnel predominantly directs towards secondary general hospitals, tertiary general hospitals, and secondary specialized hospitals. Since 2012, the number and mobility distance of primary healthcare workers have become noticeably larger and remained at a higher level from 2016 to 2020. The main migration of primary healthcare personnel occurred in their districts (counties). Key transition factors include gender, education, ethnicity, professional category, general practice registration, and administrative division. CONCLUSIONS This study provides evidence of the features of primary healthcare personnel mobility in the less developed western regions of China, in which Nanning was taken as a case study. It uncovers the factors that impact the flow of primary healthcare personnel to non-primary healthcare institutions. These findings are helpful to policy refinement and support the retention of primary healthcare workers.
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Affiliation(s)
- Xinyi Xu
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Jingyi Huang
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Xiaoqian Zhao
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Yumin Luo
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Linxuan Wang
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Yishan Ge
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Xingyin Yu
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Pinghua Zhu
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China.
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Grierson L, Mercuri M, Elma A, Mahmud M, Bakker D, Johnston N, Aggarwal M, Agarwal G. Associations between education policies and the geographic disposition of family physicians: a retrospective observational study of McMaster University education data. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:641-657. [PMID: 37581856 DOI: 10.1007/s10459-023-10273-4] [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: 02/02/2023] [Accepted: 08/06/2023] [Indexed: 08/16/2023]
Abstract
The maldistribution of family physicians challenges equitable primary care access in Canada. The Theory of Social Attachment suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University's MD Program between 2010 and 2015. Postal code data of medical graduates' residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities.
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Affiliation(s)
- Lawrence Grierson
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada.
- McMaster Education Research, Innovation and Theory, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
- McMaster Community and Rural Education Program, McMaster University, Hamilton, Canada.
| | - Mathew Mercuri
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Asiana Elma
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada
| | - Meera Mahmud
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada
| | - Dorothy Bakker
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada
- McMaster Community and Rural Education Program, McMaster University, Hamilton, Canada
| | - Neil Johnston
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Gina Agarwal
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada
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Lee JT, Crettenden I, Tran M, Miller D, Cormack M, Cahill M, Li J, Sugiura T, Xiang F. Methods for health workforce projection model: systematic review and recommended good practice reporting guideline. HUMAN RESOURCES FOR HEALTH 2024; 22:25. [PMID: 38632567 PMCID: PMC11025158 DOI: 10.1186/s12960-024-00895-z] [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: 11/20/2023] [Accepted: 01/22/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Health workforce projection models are integral components of a robust healthcare system. This research aims to review recent advancements in methodology and approaches for health workforce projection models and proposes a set of good practice reporting guidelines. METHODS We conducted a systematic review by searching medical and social science databases, including PubMed, EMBASE, Scopus, and EconLit, covering the period from 2010 to 2023. The inclusion criteria encompassed studies projecting the demand for and supply of the health workforce. PROSPERO registration: CRD 42023407858. RESULTS Our review identified 40 relevant studies, including 39 single countries analysis (in Australia, Canada, Germany, Ghana, Guinea, Ireland, Jamaica, Japan, Kazakhstan, Korea, Lesotho, Malawi, New Zealand, Portugal, Saudi Arabia, Serbia, Singapore, Spain, Thailand, UK, United States), and one multiple country analysis (in 32 OECD countries). Recent studies have increasingly embraced a complex systems approach in health workforce modelling, incorporating demand, supply, and demand-supply gap analyses. The review identified at least eight distinct types of health workforce projection models commonly used in recent literature: population-to-provider ratio models (n = 7), utilization models (n = 10), needs-based models (n = 25), skill-mixed models (n = 5), stock-and-flow models (n = 40), agent-based simulation models (n = 3), system dynamic models (n = 7), and budgetary models (n = 5). Each model has unique assumptions, strengths, and limitations, with practitioners often combining these models. Furthermore, we found seven statistical approaches used in health workforce projection models: arithmetic calculation, optimization, time-series analysis, econometrics regression modelling, microsimulation, cohort-based simulation, and feedback causal loop analysis. Workforce projection often relies on imperfect data with limited granularity at the local level. Existing studies lack standardization in reporting their methods. In response, we propose a good practice reporting guideline for health workforce projection models designed to accommodate various model types, emerging methodologies, and increased utilization of advanced statistical techniques to address uncertainties and data requirements. CONCLUSIONS This study underscores the significance of dynamic, multi-professional, team-based, refined demand, supply, and budget impact analyses supported by robust health workforce data intelligence. The suggested best-practice reporting guidelines aim to assist researchers who publish health workforce studies in peer-reviewed journals. Nevertheless, it is expected that these reporting standards will prove valuable for analysts when designing their own analysis, encouraging a more comprehensive and transparent approach to health workforce projection modelling.
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Affiliation(s)
- John Tayu Lee
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia.
| | - Ian Crettenden
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - My Tran
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Daniel Miller
- Health Data Analytics Team, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Mark Cormack
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Megan Cahill
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Jinhu Li
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Tomoko Sugiura
- Health Data Analytics Team, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Fan Xiang
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
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Mulagha-Maganga A, Kazembe L, Ndiragu M. Modeling time to death for under-five children in Malawi using 2015/16 Demographic and Health Survey: a survival analysis. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:45. [PMID: 38570888 PMCID: PMC10988915 DOI: 10.1186/s41043-024-00538-y] [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: 02/03/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Malawi has one of the highest under-five mortality rates in Sub Sahara Africa. Understanding the factors that contribute to child mortality in Malawi is crucial for the development and implementation of effective interventions to reduce child mortality. The aim of this study is to use survival analysis in modeling time to death for under-five children in Malawi. In turn, identify potential risk factors for child mortality and inform the development of interventions to reduce child mortality in the country. METHOD This study used data from all births that occurred in the five years leading up to the 2015/16 Malawi Demographic and Health Survey. The Frailty hazard model was applied to predict infant survival in Malawi. In this analysis, the outcome of interest was death and it had two possible outcomes: "dead" or "alive". Age at death was regarded as the survival time variable. Infants who were still alive at the time of the study as of the day of the interview were considered as censored observations in the analysis. RESULTS A total of 17,286 live births born during the 5 years preceding the survey were analysed. The study found that the risk of death was higher among children born to mothers aged 30-39 and 40 or older compared to teen mothers. Infants whose mothers attended fewer than four antenatal care visits were also found to be at a higher risk of death. On the other hand, the study found that using mosquito nets and early breastfeeding were associated with a lower risk of death, as were being male and coming from a wealthier household. CONCLUSION The study reveals a notable decline in infant mortality rates as under-five children age, underscoring the challenge of ensuring newborn survival. Factors such as maternal age, birth order, socioeconomic status, mosquito net usage, early breastfeeding initiation, geographic location, and child's sex are key predictors of under-five mortality. To address this, public health strategies should prioritize interventions targeting these predictors to reduce under-five mortality rates.
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Affiliation(s)
- Assa Mulagha-Maganga
- African Center of Excellence in Agriculture Policy Analysis, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
- Department of Mathematical Sciences (Biostatistics), University of Malawi, Zomba, Malawi.
- Office of Evaluations, Everest Intelligence Consult Ltd, Meanwood Kamwena, Chamba Valley, Lusaka, Zambia.
| | - Lawrence Kazembe
- Regional Office for Africa, World Health Organization (WHO), Cite du Djoue, P.O Box 06, Brazzaville, Congo
| | - Martin Ndiragu
- Department of Mathematical Sciences (Biostatistics), University of Malawi, Zomba, Malawi
- Office of Evaluations, Everest Intelligence Consult Ltd, Meanwood Kamwena, Chamba Valley, Lusaka, Zambia
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Duarte Bojikian K, Mekonnen ZK, Adan NM, Rivera-Morales P, Kombo N, Feng S. Primary Practice Emphasis Area and Diversity Among Board-Certified Ophthalmologists. Am J Ophthalmol 2024; 260:84-90. [PMID: 38103875 DOI: 10.1016/j.ajo.2023.11.026] [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: 09/25/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To describe the ophthalmology primary practice emphasis area by underrepresented in medicine (URiM) status using the American Board of Ophthalmology (ABO) Diplomates database. DESIGN Retrospective cohort study. METHODS The study was based on a retrospective review of the ABO database from 1992 to 2020. The datapoints recorded included age at time of graduation and at time of certification, sex/gender, self-reported race/ethnicity, year of graduation and of certification, region of practice in the United States, and the self-reported primary practice emphasis area within ophthalmology. The URiM cohort included self-identified Black, Hispanic/Latinx, American Indian and Alaska Native, and Native Hawaiian and Other Pacific Islander individuals. Statistical analysis was conducted using Pearson χ2, Student t, and Fisher exact tests. RESULTS A total of 575 (10.1%) ophthalmologists self-identified as URiM, vs 5132 (89.9%) as non-URiM. Diplomates who were URiM were more likely to be female and to be older at the time of ABO certification than those who were not URiM (P < .001). Over time, there was a steady decrease in the percentage of diplomates who were URiM (P < .001). There was a statistically significantly higher percentage of URiM ophthalmologists who reported glaucoma as their primary area of emphasis (P = .039) and non-URiM ophthalmologists who reported oncology, pathology, international, or genetics (P = .015), but no significant differences in the remaining subspecialties (P ≥ .123). CONCLUSIONS There were modest differences in reported ophthalmology primary practice emphasis areas between URiM and non-URiM ABO diplomates. Despite efforts to increase diversity in ophthalmology, the percentage of graduating URiM ABO diplomates has decreased over the past 2 decades.
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Affiliation(s)
- Karine Duarte Bojikian
- From the Department of Ophthalmology (K.D.B., Z.K.M., N.M.A., S.F.), University of Washington, Seattle, Washington, USA.
| | - Zesemayat K Mekonnen
- From the Department of Ophthalmology (K.D.B., Z.K.M., N.M.A., S.F.), University of Washington, Seattle, Washington, USA
| | - Najma M Adan
- From the Department of Ophthalmology (K.D.B., Z.K.M., N.M.A., S.F.), University of Washington, Seattle, Washington, USA
| | - Paola Rivera-Morales
- Department of Ophthalmology and Visual Sciences (P.R.-M., N.K.), Yale School of Medicine, New Haven, Connecticut, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Sciences (P.R.-M., N.K.), Yale School of Medicine, New Haven, Connecticut, USA
| | - Shu Feng
- From the Department of Ophthalmology (K.D.B., Z.K.M., N.M.A., S.F.), University of Washington, Seattle, Washington, USA
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Somerville JG, Strang NC, Jonuscheit S. Topical review: Task shifting and the recruitment and retention of eye health workers in underserved areas. Optom Vis Sci 2024; 101:143-150. [PMID: 38546755 DOI: 10.1097/opx.0000000000002118] [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: 04/11/2024] Open
Abstract
Many populations experience difficulty accessing eye care, especially in rural areas. Implementing workforce recruitment and retention strategies, as well as task shifting through widening scope of practice, can improve eye care accessibility. This article provides novel evidence on the compatibility of these strategies aimed at enhancing ophthalmic workforce recruitment, retention, and efficacy. PURPOSE The global burden of blindness is unequally distributed, affects rural areas more, and is frequently associated with limited access to eye care. The World Health Organization has specified both task shifting and increasing human resources for eye health as instruments to improve access to eye care in underserved areas. However, it is uncertain whether these two instruments are sufficiently compatible to provide positive synergic effects. To address this uncertainty, we conducted a structured literature review and synthesized relevant evidence relating to task shifting, workforce recruitment, retention, and eye care. Twenty-three studies from across the globe were analyzed and grouped into three categories: studies exploring recruitment and retention in human resources for eye health in general, studies discussing the relationship between task shifting and recruitment or retention of health workers in general, and studies specifically discussing task shifting and recruitment or retention in eye care workers. FINDINGS Our findings demonstrate that incentives are effective for initiating task shifting and improving recruitment and retention in rural areas with a stronger effect noted in midlevel eye care professionals and trainees. Incentives can take various forms, e.g., financial and nonfinancial. The consideration of context-specific motivational factors is essential when designing strategies to facilitate task shifting and to improve recruitment and retention.
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Barboza-Solis C, Barahona-Cubillo J, Fantin R. Health inequalities in the geographic distribution of dental practitioners in Costa Rica: An ecological study. Community Dent Oral Epidemiol 2024; 52:39-46. [PMID: 37515401 DOI: 10.1111/cdoe.12899] [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: 02/27/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE The uneven distribution of dental health services in a territory can cause an imbalance in accessibility, increasing health inequalities. This study aimed to describe the geographical distribution of dental health practitioners according to urbanicity and area-level socio-economic status in Costa Rica. METHODS A National Dentist Survey was developed to identify employment status, number of working hours, address and list of the working clinics. Data was completed using information from the national College of Surgeons, including all Costa Rican dentists. The Minimal Geographic Units (MGU) allowed for aggregating the population's individual level socio-economic position. Local Potential Accessibility (LPA) calculated the density of full-time hour's equivalents around each MGU using floating sectors. Clinics were geocoded using Geographic Information Systems, creating 2853 clinical points. Distance between each MGU and the nearest accessible clinics considering full-time working hours equivalents was estimated. MGU were divided into six categories: 'No accessibility', 'Very low accessibility', 'Low accessibility', 'Good accessibility' 'High accessibility' and 'Very high accessibility'. RESULTS Mean national LPA was 6.5 full-time equivalents per 10 000 inhabitants, 3.4% of the Costa Rican population had no access to dentist; 12.9% had very low accessibility, 22.7% had low accessibility, 35.0% had good accessibility, 16.2% had high accessibility, and 9.8% had very high accessibility. Overall, 39% of the population has a rather low accessibility. LPA was higher in urban districts compared to rural districts and in wealthiest districts compared to most disadvantaged districts. Within districts, after adjustment for district's characteristics, LPA was higher in urban MGU compared to rural MGU and in wealthiest MGU compared to most disadvantaged MGU. CONCLUSIONS This study found that despite having a high number of dentists, their numbers are small in many areas, increasing inequalities in access to health care. The dentist's free establishment, where they can decide to provide private services within a community, creates zones with very high densities, in particular in the wealthiest urban areas, and others with very low densities, in particular the poorest rural areas. The lack of territorial planning has been one of the reasons that has encouraged an imbalance in the availability of dental human resources. To achieve effective universal health coverage, public institutions should focus their efforts on improving access to dental services in underserved areas.
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Affiliation(s)
| | | | - Romain Fantin
- Centro Centroamericano de Población, Universidad de Costa Rica, San José, Costa Rica
- Facultad de Medicina, Universidad de Costa Rica, San José, Costa Rica
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
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Sadikin IS, Lestari YD, Victor AA. The role of cadre in the community on diabetic retinopathy management and its challenges in low-middle income countries: a scoping review. BMC Public Health 2024; 24:177. [PMID: 38225623 PMCID: PMC10789068 DOI: 10.1186/s12889-024-17652-5] [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: 09/15/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Diabetes is a serious public health problem, with low- and middle-income countries (LMICs) bearing over 80% of the burden. Diabetic retinopathy (DR) is one of the most prevalent diabetic microvascular problems, and early diagnosis through eye screening programs for people with diabetes is critical to prevent vision impairment and blindness. Community-based treatments, including non-physician cadres have been recommended to enhance DR care. METHODS The review protocol was determined and scoping review was conducted.The population, concept, and context were "cadre", "role of cadre in the management of DR", and LMICs". Data were collected from databases and searches, including grey literature. RESULTS Cadre can motivate people to attend a diabetic eye screening event when the rate of eye examinations is about six times higher than before the start of the intervention. Health education is a possible area for task sharing, and the cadre reported could also perform the task of vision testing. The cadre could be a good supporter and a good reminder for society. However, several challenges have been faced in this study and inadequate infrastructure is the foremost challenge found in this study. Other challenges encountered in the studies include poverty, lack of community awareness, trust issues, and low education levels contributing to poor health. CONCLUSION The current study highlighted significant gaps in the literature, which focus on the role of cadre as a community-based intervention in managing DR in LMICs. Further research is needed to develop evidence to support cost-effective screening services and cadre-related policy development in LMICs.
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Affiliation(s)
- Irma Suwandi Sadikin
- Residency Program in Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Yeni Dwi Lestari
- Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
| | - Andi Arus Victor
- Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Gjessing S, Risør T, Kristensen JK. Medical trainees' speciality considerations at their transition from under- to postgraduate education: a descriptive, cross-sectional study. EDUCATION FOR PRIMARY CARE 2024; 35:13-21. [PMID: 38431883 DOI: 10.1080/14739879.2024.2312939] [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: 04/14/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE This paper aims to provide knowledge on medical trainees' considerations about specialisation as they move from undergraduate to postgraduate medical education; especially their interest in general practice compared to other specialities. METHOD We developed and content-validated a questionnaire to examine medical trainees' speciality considerations and conducted a descriptive, cross-sectional study. All medical trainees initiating their internship in Denmark in 2022 (N = 1,188) were invited to participate in the study. Medical specialities were categorised as hospital service specialities, internal medicine specialities, primary care, psychiatry specialities and surgery and emergency specialities. Descriptive statistics were used to describe the cohort and examine the participants' speciality considerations by assigning them to one of the following three orientations: committed, undecided or non-committed to a speciality. RESULTS The response rate was 38.8% (n = 461), and participants' mean age was 27.4 years with a majority of females (68.1%). Nearly 25% of the participants had general practice as speciality preference, and only 13.9% had excluded general practice for future specialisation. Overall, around half of the participants had general practice as a first, second or third preference for specialisation. CONCLUSION Danish medical trainees show considerable interest in general practice at the time of their transition from undergraduate to postgraduate education. However, to meet future demands on the primary care, further recruitment of general practitioners is still needed. This knowledge of the specialities' recruitment potential will likely be of interest to medical educators and healthcare planners alike.
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Affiliation(s)
- Sofie Gjessing
- Centre for General Practice, Aalborg University, Aalborg East, Denmark
| | - Torsten Risør
- Section for General Practice & Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
- Section for General Practice, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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Carson DB, Messmer R, Leuf Fjällberg E. Creating 'good' hospital to home transfers in the rural north of Sweden: informal workarounds and opportunities for improvement. Home Health Care Serv Q 2024; 43:18-38. [PMID: 37439524 DOI: 10.1080/01621424.2023.2235321] [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: 07/14/2023]
Abstract
Hospital to home transfers for older people require effective communication, coordination and collaboration across multiple service settings. Rural Nursing Theory and the Beyond Periphery model explain why this is particularly difficult in rural areas, but there are few examples of how rural services respond. This paper presents a case study of the district of Tärnaby in the inland north of Sweden. Data are drawn from interviews with health and care staff in Tärnaby, observations, and experiences of the researchers. Data were analyzed thematically, with four main themes emerging - role clarity, communication, geography, and understanding of the rural context. Responses to challenges included increasing opportunities for communication between service providers and improving documentation. The paper concludes that informal "workarounds" run the risk of further disconnecting rural service settings from "the city". Rather, the aim needs to be to improve contextual understanding through formally incorporating "the rural" in service design.
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Affiliation(s)
| | - Ronja Messmer
- Department of Nursing, Umeå University, Umea, Sweden
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Macias V, Garcia Z, Pavlis W, Hill S, Fowler Z, del Valle DD, Uribe-Leitz T, Gilbert H, Roa L, Good MJD. Rethinking referral systems in rural chiapas: A mixed methods study. DIALOGUES IN HEALTH 2023; 3:100156. [PMID: 38515804 PMCID: PMC10953926 DOI: 10.1016/j.dialog.2023.100156] [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: 05/12/2023] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 03/23/2024]
Abstract
Background Despite the assurance of universal health coverage, large disparities exist in access to surgery in the state of Chiapas. The purpose of this study was to determine the effectiveness of the surgical referral system at hospitals operated by the Ministry of Health in Chiapas. Methods 13 variables were extracted from surgical referrals data from three public hospitals in Chiapas over a three-year period. Interviews were performed of health care workers involved in the referral system and surgical patients. The quantitative and qualitative data was analyzed convergently and reported using a narrative approach. Findings In total, only 47.4% of referred patients requiring surgery received an operation. Requiring an elective, gynecological, or orthopedic surgery and each additional surgery cancellation were significantly associated with lower rates of receiving surgery. The impact of gender and surgical specialty, economic fragility of farmers, dependence upon economic resources to access care, pain leading people to seek care, and futility leading patients to abandon the public system were identified as main themes from the mixed methods analysis. Interpretation Surgical referral patients in Chiapas struggle to navigate an inefficient and expensive system, leading to delayed care and forcing many patients to turn to the private health system. These mixed methods findings provide a detailed view of often overlooked limitations to universal health coverage in Chiapas. Moving forward, this knowledge must be applied to improve referral system coordination and provide hospitals with the necessary workforce, equipment, and protocols to ensure access to guaranteed care. Funding Harvard University and the Abundance Fund provided funding for this project. Funding sources had no role in the writing of the manuscript or decision to submit it for publication.
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Affiliation(s)
| | | | - William Pavlis
- Department of Orthopaedics, University of Miami, Miami, FL, USA
| | - Sarah Hill
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Zachary Fowler
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Diana D. del Valle
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Tarsicio Uribe-Leitz
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, USA
- Epidemiology, Department for Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Hannah Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- University of Alberta, Edmonton, Canada
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Vatandoost V, Tabatabaee SS, Okhovati M, Barooni M. Explaining the challenges of resources management and its underlying factors in COVID-19 era in Iran: a qualitative study. BMC Public Health 2023; 23:2118. [PMID: 37891547 PMCID: PMC10612242 DOI: 10.1186/s12889-023-17045-0] [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: 07/29/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Identifying factors affecting health costs can contribute to formulating the best policies for controlling and managing health costs. To this end, the present study aimed to analyze resource wastage and identify the factors underlying it in COVID-19 management in Iran's health sector. METHOD This qualitative content analysis study was conducted in Iran's health sector. The participants were 23 senior, middle, and operational managers in the health sector. The data were collected through semistructured interviews with the managers. The participants were selected using purposive, quota, and snowball sampling techniques. The interviews continued until the data were saturated. The collected data were analyzed using MAXQDA software (version 10). RESULTS Following the data analysis, the factors affecting the wastage of health resources were divided into 4 themes and 13 main themes. Vaccines, diagnostic kits, medicines, and human resources were the main factors underlying resource wastage. The identified main themes were open and unused vials, nonuse of distributed vaccines and their expiration, excess supply and decreased demand for vaccines, expiration of diagnostic and laboratory kits and their quantitative and qualitative defects, and the large number of tests. Inefficiency and the expiration of COVID-19 drugs, poor drug supply and consumption chain management, inaccuracy in inventory control and expiration dates, disorganization and inconsistency in the distribution of healthcare staff, low productivity of the staff, and failure to match the staff's skills with assigned tasks in selected centers were identified as the most important causes of resource wastage. CONCLUSION Given the limited health funds and the increased healthcare costs, effective preparation and planning and making reasonable decisions for unexpected events can minimize unnecessary costs and resource wastage, which requires some revisions in attitudes toward COVID-19 management in the healthcare sector.
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Affiliation(s)
- Vahid Vatandoost
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Saeed Tabatabaee
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Okhovati
- Department of Library and Medical Information, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohsen Barooni
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Shannon B, Bowles KA, Williams C, Ravipati T, Deighton E, Andrew N. Does a Community Care programme reach a high health need population and high users of acute care hospital services in Melbourne, Australia? An observational cohort study. BMJ Open 2023; 13:e077195. [PMID: 37751947 PMCID: PMC10533720 DOI: 10.1136/bmjopen-2023-077195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE The Community Care programme is an initiative aimed at reducing hospitalisations and emergency department (ED) presentations among patients with complex needs. We aimed to describe the characteristics of the programme participants and identify factors associated with enrolment into the programme. DESIGN This observational cohort study was conducted using routinely collected data from the National Centre for Healthy Ageing data platform. SETTING The study was carried out at Peninsula Health, a health service provider serving a population in Melbourne, Victoria, Australia. PARTICIPANTS We included all adults with unplanned ED presentation or hospital admission to Peninsula Health between 1 November 2016 and 31 October 2017, the programme's first operational year. OUTCOME MEASURES Community Care programme enrolment was the primary outcome. Participants' demographics, health factors and enrolment influences were analysed using a staged multivariable logistic regression. RESULTS We included 47 148 adults, of these, 914 were enrolled in the Community Care programme. Participants were older (median 66 vs 51 years), less likely to have a partner (34% vs 57%) and had more frequent hospitalisations and ED visits. In the multivariable analysis, factors most strongly associated with enrolment included not having a partner (adjusted OR (aOR) 1.83, 95% CI 1.57 to 2.12), increasing age (aOR 1.01, 95% CI 1.01 to 1.02), frequent hospitalisations (aOR 7.32, 95% CI 5.78 to 9.24), frequent ED visits (aOR 2.0, 95% CI 1.37 to 2.85) and having chronic diseases, such as chronic pulmonary disease (aOR 2.48, 95% CI 2.06 to 2.98), obesity (aOR 2.06, 95% CI 1.39 to 2.99) and diabetes mellitus (complicated) (aOR 1.75, 95% CI 1.44 to 2.13). Residing in aged care home and having high socioeconomic status) independently associated with reduced odds of enrolment. CONCLUSIONS The Community Care programme targets patients with high-readmission risks under-representation of individuals residing in residential aged care homes warrants further investigation. This study aids service planning and offers valuable feedback to clinicians about programme beneficiaries.
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Affiliation(s)
- Brendan Shannon
- Department of Paramedicine, Monash University, Franskton, Victoria, Australia
| | - Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Franskton, Victoria, Australia
| | - Cylie Williams
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Tanya Ravipati
- Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, Victoria, Australia
| | - Elise Deighton
- Community Care, Peninsula Health, Frankston, Victoria, Australia
| | - Nadine Andrew
- Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, Victoria, Australia
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Fan S, Kong F, Li C. Research on the impact of the development of green finance in the China region on residents' health. Front Public Health 2023; 11:1250600. [PMID: 37637812 PMCID: PMC10457142 DOI: 10.3389/fpubh.2023.1250600] [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: 06/30/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
In the context of implementing the strategy of "double carbon" and "healthy China," this paper firstly measures the level of green finance development and the comprehensive index of health care accessibility in each province by using the entropy weight method based on 30 provincial panel data from 2007 to 2021. A panel fixed effects model was also used to empirically analyze the effect of regional green finance development on the improvement of residents' health. In addition, a panel threshold model was constructed to empirically test the threshold effect of green finance on residents' health under the influence of four external environments: carbon intensity level, healthcare accessibility, residents' living standard and human capital level. The empirical results show that the regional green financial development in China significantly improves the health level of residents. And the impact has significant regional heterogeneity, as shown in the improvement effect is more significant for the provinces in the central and western regions. In addition, the impact of green financial development on the health level of residents in China is non-linearly influenced by external environmental factors. The improvement effect of green finance on residents' health level is more significant in the provinces with higher carbon intensity level, residents' living standard, human capital level and lower accessibility to medical services. In this regard, regional governments should continue to build and optimize a synergistic development ecosystem of green finance and public health, give full play to the advantages of financial leverage, promote green, low-carbon and high-quality economic and social development, and realize the beautiful vision of harmonious coexistence between human beings and nature.
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Affiliation(s)
- Shuhao Fan
- Quality Management Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fanchao Kong
- School of Statistics and Mathematics, Shandong University of Finance and Economics, Jinan, China
| | - Cheng Li
- Quality Management Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Domapielle MK, Dassah C, Dordaa F, Cheabu BSN, Sulemana M. Barriers to health care access and utilization among aged indigents under the Livelihood Empowerment Against Poverty Programme (LEAP): the perspective of users and service providers in north-western Ghana. Prim Health Care Res Dev 2023; 24:e48. [PMID: 37486286 PMCID: PMC10372762 DOI: 10.1017/s1463423623000385] [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: 07/25/2023] Open
Abstract
AIM This article draws on the poverty and access to health care framework to explore the barriers to access and utilization of primary health care among aged indigents under the Livelihood Empowerment Against Poverty Programme (LEAP) in Ghana. BACKGROUND Although many developing countries have made progress in extending primary health care to their populations following the Alma-Ata Declaration of 1978, the establishment of the Millennium Development Goals, and the Sustainable Development Goals (SDGs), barriers remain pervasive, particularly among vulnerable population groups. Previous studies have hardly paid in-depth attention to this important indicator for measuring progress toward achieving SDG 3. METHODOLOGY To this end, we conducted a case study of access to health care services and utilization among aged indigents enrolled on the LEAP programme in the Daffiama Bussie Issa District of the Upper West. We collected and analyzed qualitative data from indigents aged 65 years and above, health care providers, and staff of the LEAP and the National Health Insurance Scheme (NHIS). FINDINGS Our analysis found geographic inaccessibility of health care, high costs of drugs and related services, exclusion of essential services from NHIS benefits package, and irregular transfer of cash to negatively influence access and utilization of health care among aged LEAP beneficiaries in the district. In addition to the need to strengthen the economy, provide health infrastructure and human resources for health in rural areas, the government needs to review the beneficiaries' bimonthly stipends to reflect the daily minimum wage, eliminate the delay in payments, and review the benefits package of the NHIS to include essential services and medical devices commonly used by aged people. Yet implementing these recommendations has affordability implications that require innovation to mobilize additional resources and create the desired fiscal space and institutions that can sustainably implement universal coverage programmes such as the LEAP.
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Affiliation(s)
- Maximillian Kolbe Domapielle
- Department of Governance and Development Management, Faculty of Public Policy, and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, U.W.R, Ghana
- The West African Center for Sustainable Rural Transformation (WAC-SRT), Simon Diedong Dombo University of Business and Integrated Development Studies (UBIDS), Wa, U.W.R, Ghana
| | - Cornelius Dassah
- Department of Governance and Development Management, Faculty of Public Policy, and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, U.W.R, Ghana
- The West African Center for Sustainable Rural Transformation (WAC-SRT), Simon Diedong Dombo University of Business and Integrated Development Studies (UBIDS), Wa, U.W.R, Ghana
| | - Felix Dordaa
- Department of Community Development, Faculty of Planning and Land Management, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, U.W.R, Ghana
| | - Benjamin Spears Ngmekpele Cheabu
- Christian Health Association of Ghana (CHAG), HIV/TB Community Systems Strengthening Program, Accra, Ghana
- Faculty of Health Science, Health Quality Programs, Queen's University, Kingston K7L3N6, Canada
| | - Mohammed Sulemana
- Department of Governance and Development Management, Faculty of Public Policy, and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, U.W.R, Ghana
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Yan W, Qin C, Tao L, Guo X, Liu Q, Du M, Zhu L, Chen Z, Liang W, Liu M, Liu J. Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study. BMJ 2023; 381:e073043. [PMID: 37164365 PMCID: PMC10170610 DOI: 10.1136/bmj-2022-073043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To explore inequalities in human resources for health (HRH) in relation to all cause and cause specific mortality globally in 1990-2019. DESIGN Observational study. SETTING 172 countries and territories. DATA SOURCES Databases of the Global Burden of Disease Study 2019, United Nations Statistics, and Our World in Data. MAIN OUTCOME MEASURES The main outcome was age standardized all cause mortality per 100 000 population in relation to HRH density per 10 000 population, and secondary outcome was age standardized cause specific mortality. The Lorenz curve and the concentration index (CCI) were used to assess trends and inequalities in HRH. RESULTS Globally, the total HRH density per 10 000 population increased, from 56.0 in 1990 to 142.5 in 2019, whereas age standardized all cause mortality per 100 000 population decreased, from 995.5 in 1990 to 743.8 in 2019. The Lorenz curve lay below the equality line and CCI was 0.43 (P<0.05), indicating that the health workforce was more concentrated among countries and territories ranked high on the human development index. The CCI for HRH was stable, at about 0.42-0.43 between 1990 and 2001 and continued to decline (narrowed inequality), from 0.43 in 2001 to 0.38 in 2019 (P<0.001). In the multivariable generalized estimating equation model, a negative association was found between total HRH level and all cause mortality, with the highest levels of HRH as reference (low: incidence risk ratio 1.15, 95% confidence interval 1.00 to 1.32; middle: 1.14, 1.01 to 1.29; high: 1.18, 1.08 to 1.28). A negative association between total HRH density and mortality rate was more pronounced for some types of cause specific mortality, including neglected tropical diseases and malaria, enteric infections, maternal and neonatal disorders, and diabetes and kidney diseases. The risk of death was more likely to be higher in people from countries and territories with a lower density of doctors, dentistry staff, pharmaceutical staff, aides and emergency medical workers, optometrists, psychologists, personal care workers, physiotherapists, and radiographers. CONCLUSIONS Inequalities in HRH have been decreasing over the past 30 years globally but persist. All cause mortality and most types of cause specific mortality were relatively higher in countries and territories with a limited health workforce, especially for several specific HRH types among priority diseases. The findings highlight the importance of strengthening political commitment to develop equity oriented health workforce policies, expanding health financing, and implementing targeted measures to reduce deaths related to inadequate HRH to achieve universal health coverage by 2030.
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Affiliation(s)
- Wenxin Yan
- School of Public Health, Peking University, Haidian District, Beijing, China
| | - Chenyuan Qin
- School of Public Health, Peking University, Haidian District, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Haidian District, Beijing, China
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Xin Guo
- Department of Institutional Reform, National Health Commission of the People's Republic of China, Xicheng District, Beijing, China
| | - Qiao Liu
- School of Public Health, Peking University, Haidian District, Beijing, China
| | - Min Du
- School of Public Health, Peking University, Haidian District, Beijing, China
| | - Lin Zhu
- Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA
| | - Zhongdan Chen
- World Health Organization Representative Office for China, Chaoyang District, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, China
- Institute for Healthy China, Tsinghua University, Haidian District, Beijing, China
| | - Min Liu
- School of Public Health, Peking University, Haidian District, Beijing, China
| | - Jue Liu
- School of Public Health, Peking University, Haidian District, Beijing, China
- Institute for Global Health and Development, Peking University, Haidian District, Beijing, China
- Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health, Peking University, Haidian District, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Haidian District, Beijing, China
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Kolié D, Van De Pas R, Codjia L, Zurn P. Increasing the availability of health workers in rural sub-Saharan Africa: a scoping review of rural pipeline programmes. HUMAN RESOURCES FOR HEALTH 2023; 21:20. [PMID: 36918864 PMCID: PMC10013286 DOI: 10.1186/s12960-023-00801-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/07/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Rural pipeline approach has recently gain prominent recognition in improving the availability of health workers in hard-to-reach areas such as rural and poor regions. Understanding implications for its successful implementation is important to guide health policy and decision-makers in Sub-Saharan Africa. This review aims to synthesize the evidence on rural pipeline implementation and impacts in sub-Saharan Africa. METHODS We conducted a scoping review using Joanna Briggs Institute guidebook. We searched in PubMed and Google scholar databases and the grey literature. We conducted a thematic analysis to assess the studies. Data were reported following the PRISMA extension for Scoping reviews guidelines. RESULTS Of the 443 references identified through database searching, 22 met the inclusion criteria. Rural pipeline pillars that generated impacts included ensuring that more rural students are selected into programmes; developing a curriculum oriented towards rural health and rural exposure during training; curriculum oriented to rural health delivery; and ensuring retention of health workers in rural areas through educational and professional support. These impacts varied from one pillar to another and included: increased in number of rural health practitioners; reduction in communication barriers between healthcare providers and community members; changes in household economic and social circumstances especially for students from poor family; improvement of health services quality; improved health education and promotion within rural communities; and motivation of community members to enrol their children in school. However, implementation of rural pipeline resulted in some unintended impacts such as perceived workload increased by trainee's supervisors; increased job absenteeism among senior health providers; patients' discomfort of being attended by students; perceived poor quality care provided by students which influenced health facilities attendance. Facilitating factors of rural pipeline implementation included: availability of learning infrastructures in rural areas; ensuring students' accommodation and safety; setting no age restriction for students applying for rural medical schools; and appropriate academic capacity-building programmes for medical students. Implementation challenges included poor preparation of rural health training schools' candidates; tuition fees payment; limited access to rural health facilities for students training; inadequate living and working conditions; and perceived discrimination of rural health workers. CONCLUSION This review advocates for combined implementation of rural pipeline pillars, taking into account the specificity of country context. Policy and decision-makers in sub-Saharan Africa should extend rural training programmes to involve nurses, midwives and other allied health professionals. Decision-makers in sub-Saharan Africa should also commit more for improving rural living and working environments to facilitate the implementation of rural health workforce development programmes.
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Affiliation(s)
- Delphin Kolié
- Maferinyah National Training and Research Centre in Rural Health, Ministry of Health, Forecariah, Guinea.
| | - Remco Van De Pas
- Department of Public Health, Institute of Tropical Medicine of Antwerp, Antwerp, Belgium
| | - Laurence Codjia
- Department of Health Workforce, World Health Organisation, Geneva, Switzerland
| | - Pascal Zurn
- Department of Health Workforce, World Health Organisation, Geneva, Switzerland
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Ramke J, Zhao J, Wilson O, Lee A, Dakin S, Watene R, Cunningham W, Harwood M, Black J. Geographic access to eye health services in Aotearoa New Zealand: which communities are being left behind? Clin Exp Optom 2023; 106:158-164. [PMID: 35917587 DOI: 10.1080/08164622.2022.2102410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
CLINICAL RELEVANCE Efforts to provide accessible eye care must consider the extent to which travel-distance may be a barrier for some communities. BACKGROUND This study aimed to determine the distribution of - and geographic access to - eye health services in Aotearoa New Zealand. We further sought to identify communities who might benefit from provision of eye health services that were more geographically accessible. METHODS We obtained addresses of optometry and ophthalmology clinics from regulatory bodies and augmented this with online searches. Address locators were created using a Land Information dataset and geocoded using ArcGIS 10.6. A national population was derived using Statistics New Zealand's Integrated Data Infrastructure. We generated population-weighted centroids of each of New Zealand's 50,938 meshblocks and calculated the travel distance along the road network between each clinic and population (meshblock centroid). The proportion of the population living >50 km from each clinic type was calculated; as was the median, inter-quartile range and maximum distance across area-level deprivation quintiles in each district. RESULTS A national population of 4.88 million was identified, as were addresses for 344 optometry, 46 public ophthalmology and 90 private ophthalmology clinics. Nationally and within each district, travel distance to optometry was shorter than to either type of ophthalmology clinic. The region of Northland - with a high proportion of the population Māori and in the highest quintile of area-level deprivation - had the furthest average distance to travel to optometry and public ophthalmology, while the West Coast region on the South Island had the farthest to travel to private ophthalmology. Several communities were identified where longer distances intersected with higher area-level deprivation. CONCLUSION Most New Zealanders live within 10 km of eye health services. However, to achieve equitable eye health, strategies are required that make affordable eye health services accessible to communities for whom large travel distances intersect with high deprivation.
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Affiliation(s)
- Jacqueline Ramke
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jinfeng Zhao
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Oliver Wilson
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Arier Lee
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Steven Dakin
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Renata Watene
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - William Cunningham
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Matire Harwood
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna Black
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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Residents' choice of a placement in periphery hospitals in Israel: the significance of personal/family and professional considerations. Health Policy 2023; 132:104795. [PMID: 36990021 DOI: 10.1016/j.healthpol.2023.104795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/11/2022] [Accepted: 03/08/2023] [Indexed: 03/22/2023]
Abstract
Physician maldistribution affects remote and rural population health indicators and as such constitutes a major concern for health systems. Various countries, including Israel, have sought to remedy this problem, often by implementing more than one intervention simultaneously. In this paper, we explored the considerations that motivated Israeli residents to opt for a position in the periphery, as well as potential factors that could facilitate their retention in these underserved areas. We found that the motivation driving young physicians to specialize in a specific hospital includes personal- and family-oriented considerations (proximity to the nuclear family, perceived quality of life and lifestyle) as well as professional considerations (prior acquaintance with a hospital and a specific hospital department, department characteristics, availability of a residence position in a preferred specialty, prospective professional advancement). We therefore argue that the key to recruitment and retention of young physicians in remote areas lies in tailored interventions that take personal, professional and regional issues into account, preferably in consultation with the physicians themselves. The prominence of personal issues in the interviews with young physicians suggests that effective interventions should support a work-life balance. Hence success in attracting residents as a first step towards correcting physician maldistribution hinges upon coordinating policies in the medical field with policies in non-medical arenas - education, welfare, local authorities.
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Saijo Y, Yoshioka E, Sato Y, Kunori Y. Factors related to Japanese internal medicine doctors' retention or migration to rural areas: a nationwide retrospective cohort study. Environ Health Prev Med 2023; 28:14. [PMID: 36740270 PMCID: PMC9922564 DOI: 10.1265/ehpm.22-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Internal medicine (IM) doctors in Japan play the role of primary care physicians; however, the shortage of rural physicians continues. This study aims to elucidate the association of age, sex, board certification, type of work, and main clinical work with the retention or migration of IM doctors to rural areas. METHODS This retrospective cohort study included 82,363 IM doctors in 2010, extracted from the national census data of medical doctors. The explanatory variables were age, sex, type of work, primary clinical work, and changes in board certification status. The outcome was retention or migration to rural areas. The first tertile of population density (PD) of municipalities defined as rural area. After stratifying the baseline ruralities as rural or non-rural areas, the odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. The analyses were also performed after age stratification (<39, 40-59, ≥60 years old). RESULTS Among the rural areas, women had a significantly higher OR for retention, but obtaining board certification of IM subspecialties had a significantly lower OR. Among the non-rural areas, physicians who answered that their main work was IM without specific subspecialty and general had a significantly higher OR, but obtaining and maintaining board certification for IM subspecialties had a significantly lower OR for migration to rural areas. After age stratification, the higher OR of women for rural retention was significant only among those aged 40-59 years. Those aged under 40 and 40-59 years in the non-rural areas, who answered that their main work was IM without specific subspecialty had a significantly higher OR for migration to rural areas, and those aged 40-59 years in the rural areas who answered the same had a higher OR for rural retention. CONCLUSIONS Obtaining and maintaining board certification of IM subspecialties are possible inhibiting factors for rural work, and IM doctors whose main work involves subspecialties tend to work in non-rural areas. Once rural work begins, more middle-aged female IM doctors continued rural work compared to male doctors.
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Affiliation(s)
- Yasuaki Saijo
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | - Eiji Yoshioka
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | - Yukihiro Sato
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | - Yuki Kunori
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
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Murphy NJ, Groen RS. Interprofessional Care in Obstetrics and Gynecology. Obstet Gynecol Clin North Am 2022; 49:841-868. [DOI: 10.1016/j.ogc.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Moirongo RM, Aglanu LM, Lamshöft M, Adero BO, Yator S, Anyona S, May J, Lorenz E, Eibach D. Laboratory-based surveillance of antimicrobial resistance in regions of Kenya: An assessment of capacities, practices, and barriers by means of multi-facility survey. Front Public Health 2022; 10:1003178. [PMID: 36518572 PMCID: PMC9742437 DOI: 10.3389/fpubh.2022.1003178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Adequate laboratory capacity is critical in the implementation of coherent surveillance for antimicrobial resistance (AMR). We describe capacities and deficiencies in laboratory infrastructure and AMR surveillance practices among health facilities in Kenya to support progress toward broader sustainable laboratory-based AMR surveillance. Methods A convenience sample of health facilities from both public and private sectors across the country were selected. Information was obtained cross-sectionally between 5th October and 8th December 2020 through online surveys of laboratory managers. The assessment covered quality assurance, management and dissemination of AMR data, material and equipment, staffing, microbiology competency, biosafety and certification. A scoring scheme was developed for the evaluation and interpreted as (80% and above) facility is adequate (60-79%) requires some strengthening and (<60%) needing significant strengthening. Average scores were compared across facilities in public and private sectors, rural and urban settings, as well as national, county, and community levels. Results Among the participating facilities (n = 219), the majority (n = 135, 61.6%) did not offer bacterial culture testing, 47 (21.5%) offered culture services only and 37 (16.9%) performed antimicrobial susceptibility testing (AST). The major gaps identified among AST facilities were poor access to laboratory information management technology (LIMT) (score: 45.9%) and low uptake of external quality assessment (EQA) programs for cultures (score 67.7%). Access to laboratory technology was more than two-fold higher in facilities in urban (58.6%) relative to rural (25.0%) areas. Whilst laboratories that lacked culture services were found to have significant infrastructural gaps (average score 59.4%), facilities that performed cultures only (average score: 83.6%) and AST (average score: 82.9%) recorded significantly high scores that were very similar across areas assessed. Lack of equipment was identified as the leading challenge to the implementation of susceptibility testing among 46.8% of laboratories. Conclusions We identified key gaps in laboratory information management technology, external quality assurance and material and equipment among the surveyed health facilities in Kenya. Our findings suggest that by investing in equipment, facilities performing cultures can be successfully upgraded to provide additional antimicrobial susceptibility testing, presenting a chance for a major leap toward improved AMR diagnostics and surveillance in the country.
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Affiliation(s)
- Rehema Moraa Moirongo
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,*Correspondence: Rehema Moraa Moirongo
| | - Leslie Mawuli Aglanu
- Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana,Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Maike Lamshöft
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,German Center for Infection Research (DZIF), Braunschweig, Germany
| | | | - Solomon Yator
- Department of Biochemistry and Molecular Biology, University of Bremen, Bremen, Germany
| | - Stephen Anyona
- Centre for Microbiology Research (KEMRI-CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,German Center for Infection Research (DZIF), Braunschweig, Germany,Department of Tropical Medicine I, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Eva Lorenz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,German Center for Infection Research (DZIF), Braunschweig, Germany,Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
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Dzampe AK, Takahashi S. Competition and quality of care under regulated fees: evidence from Ghana. HEALTH ECONOMICS REVIEW 2022; 12:57. [PMID: 36355234 PMCID: PMC9647994 DOI: 10.1186/s13561-022-00406-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND How competition affects the quality of care is still not well understood empirically because of limited and mixed results. This study examined whether competition leads to higher or lower quality health outcomes in Ghana. METHODS We used administrative claims data of hypertension patients for 2017 - 2019 (36 months), and an instrumental variable method to examine the effect of competition, measured as an increase in district doctor-to-population ratio on hospital-level ambulatory care sensitive condition hospitalization and in-hospital death rates. RESULTS Overall, we found that an increase in doctor density improves the quality of care for hypertension patients in Ghana. That is, when there are more doctors, fewer patients are hospitalized, and the risk of in-hospital deaths decreases. This result is robust to analyses at the individual and district population levels for ambulatory care sensitive hospitalizations rate. CONCLUSIONS Our findings suggest that in the presence of physician-induced demand, competition can lead to improvement in the quality of care, possibly through improved access to healthcare and increased physician time and contact per patient. Future health policies need to consider possible welfare benefits of induced medical services and training more doctors.
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Affiliation(s)
- Adolf Kwadzo Dzampe
- Japan Development Service (JDS) PhD Fellow, Graduate School for International Development and Cooperation, Hiroshima University, 1-5-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8529 Japan
- Claims Processing Centre, National Health Insurance Authority, PMB Ministries, Accra, Ghana
| | - Shingo Takahashi
- Associate Professor, Graduate School for International Development and Cooperation, Hiroshima University, 1-5-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8529 Japan
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Muho A, Peshkatari A, Wyss K. Work time allocation at primary health care level in two regions of Albania. PLoS One 2022; 17:e0276184. [PMID: 36288384 PMCID: PMC9605026 DOI: 10.1371/journal.pone.0276184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Although well-performing workforce is essential to equitable and efficient health service delivery, few countries have systematically addressed performance improvements. How health workers use their work time and what tasks they accomplish is here an important starting point. Therefore, a time motion study was conducted to assess the work time allocation patterns of primary health care doctors and nurses in two regions of Albania. Methods We used observation tool to record the time allocation along eight predefined main categories of activities. Conditional to presence at work, 48 health workers were continuously observed in early 2020 before start of the Covid-19 pandemic over five consecutive working days. Results The observed health workers spent 40.7% of their overall working time unproductively (36.8% on waiting for patients and 3.9% on breaks), 25.3% on service provision to users, 18.7% on administrative activities, 12.7% on outreach activities, 1.6% on continuous medical education and 1% on meetings. The study found variations in work time allocation patterns across cadres, with nurses spending more time unproductively, on administrative activities and on outreach and less on all other activities than doctors. Further, the work time allocation patterns were similar between urban and rural settings, except for nurses in rural settings spending less time than those in urban settings on administrative work. Conclusion This study found that primary health care workers in Albania devote a substantial amount of work time to unproductive, service provision to users and administrative activities. Consequently, there is possibility for productivity, respectively efficiency gains in how health workers use their time.
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Affiliation(s)
- Altiona Muho
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | | | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Johnson A, Soto Mas F, Nervi L, Erhardt E, Qeadan F. We Need You Here! Predictors of Job Placement and Practice among New Mexico Family Medicine Residents. South Med J 2022; 115:734-739. [DOI: 10.14423/smj.0000000000001451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Schnack H, Uthoff SAK, Ansmann L. The perceived impact of physician shortages on human resource strategies in German hospitals - a resource dependency perspective. J Health Organ Manag 2022; 36:196-211. [PMID: 36098505 DOI: 10.1108/jhom-05-2021-0203] [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: 11/17/2022]
Abstract
PURPOSE Like other European countries, Germany is facing regional physician shortages, which have several consequences on patient care. This study analyzes how hospitals perceive physician shortages and which strategies they adopt to address them. As a theoretical framework, the resource dependency theory is chosen. DESIGN/METHODOLOGY/APPROACH The authors conducted 20 semi-structured expert interviews with human resource officers, human resource directors, and executive directors from hospitals in the northwest of Germany. Hospitals of different ownership types, of varying sizes and from rural and urban locations were included in the sample. The interviews were analyzed by using qualitative content analysis. FINDINGS The interviewees reported that human resource departments in hospitals expand their recruiting activities and no longer rely on one single recruiting instrument. In addition, they try to adapt their retaining measures to physicians' needs and offer a broad range of employment benefits (e.g. childcare) to increase attractiveness. The study also reveals that interviewees from small and rural hospitals report more difficulties with attracting new staff and therefore focus on recruiting physicians from abroad. PRACTICAL IMPLICATIONS Since the staffing situation in German hospitals will not change in the short term, the study provides suggestions for hospital managers and health policy decision-makers in dealing with physician shortages. ORIGINALITY/VALUE This study uses the resource dependency theory to explain hospitals' strategies for dealing with healthcare staff shortages for the first time.
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Affiliation(s)
- Helge Schnack
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Sarah Anna Katharina Uthoff
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Bayati M, Rashidian A, Yazdi-Feyzabadi V, Delavari S. Influencing factors on the tendency of general practitioners to join in urban family physician program: a cross-sectional survey on Iranian physicians. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:41. [PMID: 35978402 PMCID: PMC9386937 DOI: 10.1186/s12962-022-00373-0] [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: 08/12/2021] [Accepted: 07/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Urban family physician program (UFPP) is initiated as pilot by policy makers as a main reform in future of primary health care in Iran. Despite an ongoing pilot implementation of this program from 2012, it remains a main question about providing sufficient number of general practitioners (GPs). This study aimed to investigate the factors which affect GPs’ decision to join in the UFPP. Methods In this national cross-sectional study a sample of 666 GPs, using convenience sampling, filled a self-report questionnaire. The multivariate logistic regression was applied to explore the demographic, practice and views determinants of the tendency of GPs to join in the UFPP. Results More than half of GPs (58.6%) participated in the study had a positive tendency to join in the UFPP. Older GPs (adjusted OR = 3.72; 95%CI 1.05–13.09), working in public sector (adjusted OR = 2.26; 95%CI 1.43–3.58), lower income level (adjusted OR = 6.69; 95%CI 2.95–15.16), higher economic expectations (adjusted OR = 2.08; 95%CI 1.19–3.63), and higher satisfaction from medicine profession (adjusted OR = 2.00; 95%CI 1.14–3.51) were the main factors which increased the GPs tendency to enter in UFPP. Conclusions Decision for joining in the program is mainly affected by GPs’ economic status. This clarifies that if the program can make them closer to their target income, they would be more likely to decide for joining in the program.
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Affiliation(s)
- Mohsen Bayati
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Rashidian
- Department of Science, Information and Dissemination, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Nyawira L, Tsofa B, Musiega A, Munywoki J, Njuguna RG, Hanson K, Mulwa A, Molyneux S, Maina I, Normand C, Jemutai J, Barasa E. Management of human resources for health: implications for health systems efficiency in Kenya. BMC Health Serv Res 2022; 22:1046. [PMID: 35974324 PMCID: PMC9382760 DOI: 10.1186/s12913-022-08432-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Human resources for health consume a substantial share of healthcare resources and determine the efficiency and overall performance of health systems. Under Kenya’s devolved governance, human resources for health are managed by county governments. The aim of this study was to examine how the management of human resources for health influences the efficiency of county health systems in Kenya. Methods We conducted a case study using a mixed methods approach in two purposively selected counties in Kenya. We collected data through in-depth interviews (n = 46) with national and county level HRH stakeholders, and document and secondary data reviews. We analyzed qualitative data using a thematic approach, and quantitative data using descriptive analysis. Results Human resources for health in the selected counties was inadequately financed and there were an insufficient number of health workers, which compromised the input mix of the health system. The scarcity of medical specialists led to inappropriate task shifting where nonspecialized staff took on the roles of specialists with potential undesired impacts on quality of care and health outcomes. The maldistribution of staff in favor of higher-level facilities led to unnecessary referrals to higher level (referral) hospitals and compromised quality of primary healthcare. Delayed salaries, non-harmonized contractual terms and incentives reduced the motivation of health workers. All of these effects are likely to have negative effects on health system efficiency. Conclusions Human resources for health management in counties in Kenya could be reformed with likely positive implications for county health system efficiency by increasing the level of funding, resolving funding flow challenges to address the delay of salaries, addressing skill mix challenges, prioritizing the allocation of health workers to lower-level facilities, harmonizing the contractual terms and incentives of health workers, and strengthening monitoring and supervision.
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Affiliation(s)
- Lizah Nyawira
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benjamin Tsofa
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Anita Musiega
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Joshua Munywoki
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Rebecca G Njuguna
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Kara Hanson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Mulwa
- Directorate of Medical Services, preventive and promotive health, Ministry of Health, Nairobi, Kenya
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Isabel Maina
- Health Financing Department, Ministry of Health, Nairobi, Kenya
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College, the University of Dublin, Dublin, Ireland
| | - Julie Jemutai
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Institute of Healthcare Management, Strathmore Business School, Strathmore University, Nairobi, Kenya.
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Mohedas I, Bell C, Bekele D, Jiang K, Soyars C, Walsh M, Sienko K. Pre-Clinical Evaluation of a Task-Shifting Contraceptive Implant Insertion Device for Use in Low- and Middle-Income Countries. J Med Device 2022. [DOI: 10.1115/1.4054684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Worldwide, 225 million women have unmet contraceptive needs which, every year, leads to 52 million unintended pregnancies. A challenge to providing universal access to contraception is the large proportion of the population living in rural, difficult to access settings in low- and middle-income countries. The availability and delivery of effective contraception in rural areas is limited by the lack of trained healthcare providers. Barriers to the use of long-acting contraceptives in rural areas are more pronounced due to the advanced skill and training to administer. In this study, we describe the design and testing of the SubQ Assist, a task-shifting contraceptive implant insertion device that aims to reduce the training requirements for administering contraceptive implants while simultaneously ensuring safe and high quality administration. Cadaver testing in conjunction with ultrasound depth measurements were used to evaluate the efficacy of the SubQ Assist. Implant insertion between the SubQ Assist and a trained physician are compared. Cadaver testing and ultrasound depth measurements demonstrate that the SubQ Assist results in implant insertions that are statistically equivalent to implants inserted by a trained physician. Additionally, the results show that the lateral positioning of these implants would facilitate uncomplicated removal at a later date. These findings demonstrate proof of concept for the SubQ Assist and provide evidence for moving towards clinical testing. They demonstrate that the SubQ Assist may be an effective method of task-shifting the insertion of contraceptive implants to minimally trained providers in order to expand access in rural areas.
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Affiliation(s)
- Ibrahim Mohedas
- University of Michigan, Department of Mechanical Engineering , 2350 Hayward St, Ann Arbor, Michigan, USA
| | - Carrie Bell
- University of Michigan, Department of Obstetrics and Gynecology , 1500 East Medical Center Drive, Ann Arbor, MI, USA
| | - Delayehu Bekele
- St. Paul's Hospital Millennium Medical College, Department of Obstetrics and Gynecology , P.O. Box 1271, Gulele Addis Ababa 1000, Ethiopia
| | - KevinC Jiang
- University of Michigan, Department of Biomedical Engineering , 2200 Bonisteel Blvd, Ann Arbor, MI, USA
| | - Caroline Soyars
- University of Michigan, Department of Mechanical Engineering , 2350 Hayward St, Ann Arbor, Michigan, USA
| | - Madeleine Walsh
- University of Michigan, School of Nursing , 426 N Ingalls St, Ann Arbor, Michigan, USA
| | - Kathleen Sienko
- University of Michigan, Department of Mechanical Engineering , 2350 Hayward St, Ann Arbor, Michigan, USA
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Zegeye B, Anyiam FE, Ahinkorah BO, Ameyaw EK, Budu E, Seidu AA, Yaya S. Women's decision-making capacity and its association with comprehensive knowledge of HIV/AIDS in 23 sub-Saharan African countries. Arch Public Health 2022; 80:111. [PMID: 35387689 PMCID: PMC8985301 DOI: 10.1186/s13690-022-00849-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, Human Immunodeficiency Virus (HIV) that causes Acquired Immunodeficiency Syndrome (AIDS) remains a public health problem with a higher burden in sub-Saharan African countries. Though the coverage is low in sub-Saharan Africa (SSA), comprehensive knowledge about HIV is vital for preventing and controlling the transmission of the virus. Women's decision-making power is significantly linked with the knowledge and use of healthcare services. However, there is no available evidence on women's decision-making capacity and comprehensive knowledge of HIV. Therefore, this study investigated the association between women's decision-making capacity within households and comprehensive knowledge of HIV/AIDS in SSA. METHODS We derived data from the 2010 to 2020 Demographic and Health Surveys of 23 sub-Saharan African countries for the analysis. Using Stata version 14, both bivariate logistic regression and multivariate multilevel logistic regression analyses were used to examine the association between women's decision-making capacity and comprehensive knowledge of HIV/AIDS at p ≤ 0.05. Results were reported using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI). RESULTS The pooled results show that comprehensive HIV/AIDS knowledge among married women in the studied countries was 35.5%, from 18.3% in Chad to 77.1% in Rwanda. Regarding sub-regional distribution, comprehensive knowledge of HIV/AIDS in Southern Africa was 73.2%, followed by East Africa (52.4%), West Africa (43.6%), and Central Africa (35.5%). The study showed higher odds of comprehensive knowledge of HIV/AIDS among married women who had decision making power (yes-aOR = 1.20, 95% CI; 1.16-1.25) compared to those who had no decision-making power. Age, women and partner's level of education, place of residence, exposure to media, HIV testing status, community socio-economic status, parity, religion, and distance to health facilities also had significant association with comprehensive HIV/AIDS knowledge. CONCLUSIONS Comprehensive knowledge of HIV/AIDS in SSA is low but varies per country. Married women with decision-making capacity were more likely to have comprehensive knowledge of HIV compared to those with no decision-making capacity. Therefore, comprehensive knowledge of HIV/AIDS can be increased through enhancing women's decision-making capacities, strengthening employment opportunities, socioeconomic capacities and creating awareness through media. Moreover, improving access to health care facilities working closely with religious leaders, can be considered to increase coverage of comprehensive knowledge of HIV among married women in SSA.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, , Shewarobit Field Office, Shewarobit, Ethiopia
| | - Felix Emeka Anyiam
- Centre for Health and Development, University of Port Harcourt, Port Harcourt, Nigeria
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Estate Management, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana.,Centre for Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, QLD4811, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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Ellis R, Cleland J, Lee AJ, Scrimgeour DSG, Brennan PA. A cross-sectional study examining MRCS performance by core surgical training location. MEDICAL TEACHER 2022; 44:388-393. [PMID: 34727832 DOI: 10.1080/0142159x.2021.1995599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND In the UK, core surgical training (CST) is the first specialty experience that early-career surgeons receive but training differs significantly across CST deaneries. To identify the impact these differences have on trainee performance, we assessed whether success at the Membership of the Royal College of Surgeons (MRCS) examinations is associated with CST deanery. METHODS A retrospective cohort study of UK trainees in CST who attempted MRCS between 2014 and 2020 (n = 1104). Chi-squared tests examined associations between locality and first-attempt MRCS performance. Multivariate logistic regression models identified the likelihood of MRCS success depending on CST deanery. RESULTS MRCS Part A and Part B pass rates were associated with CST deanery (p < 0.001 and p = 0.013, respectively). Candidates that trained in Thames Valley (Odds Ratio [OR] 2.52 (95% Confidence Interval [CI] 1.00-6.42), North Central and East London (OR 2.37 [95% CI 1.04-5.40]) or South London (OR 2.36 [95% CI 1.09-5.10]) were each more than twice as likely to pass MRCS Part A at first attempt. Trainees from North Central and East London were more than ten times more likely to pass MRCS Part B at first attempt (OR 10.59 [95% CI 1.23-51.00]). However, 68% of candidates attempted Part A prior to CST and 48% attempted Part B before or during the first year of CST. CONCLUSION MRCS performance is associated with CST deanery; however, many candidates passed the exam with little or any CST experience suggesting that some deaneries attract high academic performers. MRCS performance is therefore not a suitable marker of CST training quality.
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Affiliation(s)
- Ricky Ellis
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Urology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Amanda J Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Peter A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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Nwankwo ONO, Ugwu CI, Nwankwo GI, Akpoke MA, Anyigor C, Obi-Nwankwo U, Andrew S, Nwogu K, Spicer N. A qualitative inquiry of rural-urban inequalities in the distribution and retention of healthcare workers in southern Nigeria. PLoS One 2022; 17:e0266159. [PMID: 35349602 PMCID: PMC8963562 DOI: 10.1371/journal.pone.0266159] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/15/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Globally, the population in rural communities are disproportionately cared for by only 25% and 38% of the total physicians and nursing staff, respectively; hence, the poor health outcomes in these communities. This condition is worse in Nigeria by the critical shortage of skilled healthcare workforce. This study aimed to explore factors responsible for the uneven distribution of healthcare workers (physicians and nurses) to rural areas of Ebonyi State, Nigeria. Methods Qualitative data were obtained using semi-structured in-depth interviews and focus group discussions from purposively selected physicians, nurses, and policymakers in the state. Data was analysed for themes related to factors influencing the mal-distribution of healthcare workers (physicians and nurses) to rural areas. The qualitative analysis involved the use of both inductive and deductive reasoning in an iterative manner. Results This study showed that there were diverse reasons for the uneven distribution of skilled healthcare workers in Ebonyi State. This was broadly classified into three themes; socio-cultural, healthcare system, and personal healthcare workers’ intrinsic factors. The socio-cultural factors include symbolic capital and stigma while healthcare system and governance issues include poor human resources for health policy and planning, work resources and environment, decentralization, salary differences, skewed distribution of tertiary health facilities to urban area and political interference. The intrinsic healthcare workers’ factors include career progression and prospect, negative effect on family life, personal characteristics and background, isolation, personal perceptions and beliefs. Conclusions There may be a need to implement both non-financial and financial actions to encourage more urban to rural migration of healthcare workers (physicians and nurses) and to provide incentives for the retention of rural-based health workers.
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Affiliation(s)
| | | | - Grace I. Nwankwo
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Collins Anyigor
- Department of Family Medicine, Federal Medical Center, Abuja, Nigeria
| | - Uzoma Obi-Nwankwo
- Detar/A&M University FM Residency Program, Victoria, Texas, United States of America
| | - Sunday Andrew
- Christian Medical and Dental Association, National Office, Abuja, Nigeria
| | | | - Neil Spicer
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Righi L, Cullati S, Chopard P, Courvoisier DS. General and Vulnerable Population’s Satisfaction With the Healthcare System in Urban and Rural Areas: Findings From the European Social Survey. Int J Public Health 2022; 67:1604300. [PMID: 35330661 PMCID: PMC8938939 DOI: 10.3389/ijph.2022.1604300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/04/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Access to the healthcare system when patients are vulnerable and living outside metropolitan areas can be challenging. Our objective was to explore healthcare system satisfaction of urban and rural inhabitants depending on financial and health vulnerabilities. Methods: Repeated cross-sectional data from 353,523 European citizens (2002–2016). Multivariable associations between rural areas, vulnerability factors and satisfaction with the healthcare system were assessed with linear mixed regressions and adjusted with sociodemographic and control factors. Results: In unadjusted analysis, the people who lived in houses in the countryside and those who lived in the suburbs were the most satisfied with the healthcare system. In the adjusted model, residents living in big cities had the highest satisfaction. Financial and health vulnerabilities were associated with less satisfaction with the healthcare system, with a different effect according to the area of residence: the presence of health vulnerability was more negatively correlated with the healthcare system satisfaction of big city inhabitants, whereas financial vulnerability was more negatively correlated with the satisfaction of those living in countryside homes. Conclusion: Vulnerable residents, depending on their area of residence, may require special attention to increase their satisfaction with the healthcare system.
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Affiliation(s)
- Lorenzo Righi
- Quality of Care and Clinical Networks, Health Directorate of the Tuscany Region, Florence, Italy
- *Correspondence: Lorenzo Righi,
| | - Stéphane Cullati
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
- Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Pierre Chopard
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Delphine S. Courvoisier
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
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Noochpoung R, Hung P, Hair NL, Putthasri W, Chen B. Can a High-Powered Financial Incentive Program Reduce Resignation Rates among Healthcare Providers in Rural Areas? Evidence from Thailand's 2008 Hardship Allowance Program. Health Policy Plan 2022; 37:624-633. [PMID: 35233635 DOI: 10.1093/heapol/czac018] [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: 08/28/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
Abstract
Geographic disparities in the availability of healthcare providers remain a global health challenge. Financial incentives have been widely implemented to attract rural healthcare workers with limited scientific evidence in developing economies. In this study, we investigate the relationship between financial incentives and rural resignations in a middle-income country using Thailand's Hardship Allowance program that first doubled or tripled but later decreased direct payments to rural providers. This retrospective observational study used data on dentists' work status from the Human Resource Management Department at the Ministry of Public Health in Thailand. Segmented regression and difference-in-differences approaches were used to analyze the effect of changes to the Hardship Allowance on rural dentists' resignation and relocation patterns. We found that the dramatic increase in the Hardship Allowance in 2008 was associated with a decrease in resignation rates among dentists in rural areas. However, after Thailand recategorized certain rural districts into urban areas in 2016, dentists were more likely to relocate from the newly urbanized areas to established urban centers, likely due in part to reductions in the Hardship Allowance that accompanied recategorization. However, we did not find that resignations increased in these affected areas. Finally, in a subgroup analysis, we found that older dentists were less likely than younger dentists to relocate from areas affected by the 2016 rural-to-urban recategorization. Overall, our study found that a dramatic increase in financial incentives reduced resignation rates in rural Thailand, but a reversal of the incentives as a result of rural-to-urban reclassification resulted in relocations from the affected areas to established urban centers. When considering their strategic goals of equitable healthcare workforce distribution, policy makers should be aware that both direct and indirect changes to payment incentives may affect dentists' resignation and practice location decisions, and that these decisions may be influenced by provider demographics.
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Affiliation(s)
| | - Peiyin Hung
- Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, USA
| | - Nicole L Hair
- Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, USA
| | | | - Brian Chen
- Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, USA
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Beattie J, Binder MJ, Fuller L. Rural longitudinal integrated clerkships and medical workforce outcomes: a scoping review protocol. BMJ Open 2022; 12:e058717. [PMID: 35236734 PMCID: PMC8896063 DOI: 10.1136/bmjopen-2021-058717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The shortage of doctors in rural locations is an international problem, contributing to limited access to healthcare and a health disparity between rural and metropolitan populations. To encourage additional doctors to work in rural locations, more doctors than ever are being trained in rural settings. One rural clerkship model that is gaining recognition for fostering rural careers is the Longitudinal Integrated Clerkship. Longitudinal Integrated Clerkship programmes vary in terms of settings and durations, but at their core have the fundamental commonality of continuity, with students learning the curriculum in an integrated manner. The scoping review will synthesise the literature pertaining to medical workforce outcomes of rural Longitudinal Integrated Clerkship programmes, to uncover areas that require further research and establish elements of medical education programme design that positively influence rural workforce outcomes. METHODS AND ANALYSIS The review will follow Arksey and O'Malley's six step scoping review framework. MEDLINE, CINAHL complete (EBSCOhost), Scopus, Embase (Elsevier) and ISI Web of Science databases will be searched along with Google, Google Scholar, ProQuest and WHO library database. Single design studies examining the geographic work locations and/or medical specialty of rural Longitudinal Integrated Clerkship graduates will be included. Data from quantitative and mixed-methods studies will be included. Only studies written in English will be included. There will be no date range restriction imposed on the reviewed studies. Two reviewers will independently screen and critically appraise the articles to determine if they meet the inclusion criteria. Data from eligible studies will be extracted for synthesis. ETHICS AND DISSEMINATION Scoping reviews do not require ethics approval. Results will be submitted to a peer-reviewed journal and may be presented at relevant conferences. The findings will also be shared within the Longitudinal Integrated Clerkship community of medical educators.
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Affiliation(s)
- Jessica Beattie
- Rural Community Clinical School, Deakin University, Warrnambool, Victoria, Australia
| | - Marley J Binder
- Deakin Rural Health, Deakin University, Geelong, Victoria, Australia
| | - Lara Fuller
- Rural Community Clinical School, Deakin University, Colac, Victoria, Australia
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Schut RA. Disaggregating inequalities in the career outcomes of international medical graduates in the United States. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:535-565. [PMID: 35098550 PMCID: PMC8957552 DOI: 10.1111/1467-9566.13433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
Although research finds that international medical graduates (IMGs) fill gaps in US health care left by US medical graduates (USMGs), the extent to which IMGs' career outcomes are stratified along the lines of their country of medical education remains understudied. Using data from the 2019 American Medical Association Physician Masterfile (n = 19,985), I find IMGs from developed countries chart less marginalised paths in their US careers relative to IMGs from developing countries; they are more likely to practise in more competitive and popular medical specialities; to attend prestigious residency programmes; and to practise in less disadvantaged counties that employ more USMGs relative to IMGs. These findings suggest IMGs experience divergent outcomes in the United States based on their place of medical education, with IMGs from developing countries experiencing more constraints in their careers relative to IMGs from developed countries. This understudied axis of stratification in medicine has important implications for our understanding of how nativism and racism may intersect to generate inequalities in the medical profession and in US health care more broadly.
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Affiliation(s)
- Rebecca A. Schut
- Population Studies Center, University of Pennsylvania, 239 McNeil Building, 3718 Locust Walk, Philadelphia PA, 19104
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Kekulawala M, Samba A, Braunschweig Y, Plange-Rhule J, Turpin C, Johnson TRB, Anderson FWJ. Obstetric capacity strengthening in Ghana results in wide geographic distribution and retention of certified Obstetrician/Gynaecologists: A quantitative analysis. BJOG 2022; 129:1757-1761. [PMID: 35157341 DOI: 10.1111/1471-0528.17121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Melani Kekulawala
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA.,College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA
| | - Ali Samba
- Department of Obstetrics and Gynaecology, University of Ghana, Accra, Ghana
| | - Yael Braunschweig
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA.,Department of Family Medicine, Stanford University, Stanford, California, USA
| | | | - Cornelius Turpin
- Department of Obstetrics and Gynaecology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Timothy R B Johnson
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank W J Anderson
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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Yusefi AR, Sharifi M, Nasabi NS, Rezabeigi Davarani E, Bastani P. Health human resources challenges during COVID-19 pandemic; evidence of a qualitative study in a developing country. PLoS One 2022; 17:e0262887. [PMID: 35073374 PMCID: PMC8786119 DOI: 10.1371/journal.pone.0262887] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background One of the main forthcoming challenges of healthcare systems against preparedness and management of the pandemic is the challenge of procurement and recruitment of the human resources. This study is aimed to explore the health human resources challenges during COVID-19 pandemic in Iran. Methods This qualitative content analysis study was conducted in 2020. The study population includes all the Iranian human resources managers affiliated in Universities of Medical Sciences, hospitals and health centers managers and the health networks managers all over the country. 23 participants were included via purposeful sampling considering the inclusion criteria and were interviewed individually. After 23 semi-structured interviews, data were saturated. Then the data were analyzed through content analysis approach applying MAXQDA10. Results Three main themes of “organizational challenges”, “legal challenges”, and “personal challenges” were explored as the main challenges of health human resources management during COVID-19. On the one hand, organizational challenges include restricted financial resources, compensation discrimination, staffing distinction points, imbalance in the workload, weak organizational coordination, inefficient inter-sectoral relationships, parallel decisions, inefficient distribution of the human resources, lack of applied education, lack of integrated health protocols, lack of appropriate evaluation of performance, employee turnover, lack of clear approaches for staffing, and shortage of specialized manpower, and on the other hand, the personal challenges include insufficient knowledge of the employees, psychological disorders, reduction of self-confidence, burnout, workload increase, reduced level of job satisfaction, effects of colleague and patients bereavement and unsafety sense against the work place. Finally, the legal challenges that mostly related to the governments laws and regulations include lack of protocols for continuous supportive services, inappropriate approaches and instructions for teleworking, and lack of alternative plans and regulations for the human resources. Conclusion Organizational, legal and personal challenges are among three main challenges of health human resources management during COVID-19 pandemic. Serious attention to these challenges should be considered by health policymakers in order to be prepared for facing new probable outbreaks and managing the present condition. The integrated comprehensive planning of human resources management for COVID-19 along with supportive packages for the personnel can be helpful.
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Affiliation(s)
- Ali Reza Yusefi
- Department of Public Health, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Mehrdad Sharifi
- Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narjes sadat Nasabi
- Development and Change Manager, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Esmat Rezabeigi Davarani
- Health in Disasters and Emergencies Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Peivand Bastani
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- * E-mail:
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Absori A, Quinncilla KH, Rizka R, Budiono A, Surbakti N. Doctor Placement’s Policy and Its Implications in Indonesia: Legal Qualitative Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Remote, Underdeveloped Areas, Frontiers, and Islands (RUAFI) in Indonesia have a less equal distribution of doctors compared to other more developed areas, causing a decline in healthcare service quality in RUAFI and the health degree of the overall population.
AIM: This research aims to describe the policy and the implication of doctor distribution in Indonesia and to provide a proportional justice-based doctor distribution policy concept.
METHODS: This is a mixed qualitative research of juridical-normative and literature review. The laws that regulate the distribution of doctors in Indonesia are the 1945 Constitution, Law No. 36 of 2009, Law No. 26 of 2014, Governmental Decree No. 67 of 2019, Presidential Decree No. 72 of 2012, and the Decree of the Minister of Health No. 16 of 2017.
RESULTS: The unequal doctor distribution is mainly caused by the low motivation for recruitment and retention in RUAFI. The affecting factors include disparity of incentives between doctors, low regional government involvement in the healthcare system in RUAFI, and the lack of career development for doctors being placed in RUAFI.
CONCLUSION: The concept of proportional justicebased policy proposed is as follows: (a) Intensive proportionality between doctors and other types of health workers, (b) a direct regional government function of control, and (c) providing career and educational prospects.
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Kiologwe JC, Kusirye U, Hoffman A, Kalolo A. Operational challenges of engaging development partners in district health planning in Tanzania. BMC Public Health 2022; 22:200. [PMID: 35093065 PMCID: PMC8800550 DOI: 10.1186/s12889-022-12520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/28/2021] [Indexed: 05/31/2023] Open
Abstract
Background Development Assistance for Health (DAH) represents an important source of health financing in many low and middle-income countries. However, there are few accounts on how priorities funded through DAH are integrated with district health priorities. This study is aimed at understanding the operational challenges of engaging development partners in district health planning in Tanzania. Methods This explanatory mixed-methods study was conducted in Kinondoni and Bahi districts, representing urban and rural settings of the country. Data collection took place between November and December 2015. The quantitative tools (mapping checklist, district questionnaire and Development partners (DPs) questionnaire) mapped the DPs and their activities and gauged the strength of DP engagement in district health planning. The qualitative tool, a semi-structured in-depth interview guide administered to 20 key informants (the council health planning team members and the development partners) explained the barriers and facilitators of engagement. Descriptive and thematic analysis was utilized for quantitative and qualitative data analysis respectively. Results Eighty-six per cent (85%) of the development partners delivering aid in the studied districts were Non-Governmental Organizations. Twenty percent (20%) of the interventions were HIV/AIDS interventions. We found that only four (4) representing 25 % (25%) DPs had an MOU with the District Council, 56 % (56%) had submitted their plans in writing to be integrated into the 2014/15 CCHP. Six (6) representing 38 % (38%) respondents had received at least one document (guidelines, policies and other planning tools) from the district for them to use in developing their organization activity plans. Eighty-seven point 5 % (87.5%) from Bahi had partial or substantial participation, in the planning process while sixty-two point 5 % (62.5%) from Kinondoni had not participated at all (zero participation). The operational challenges to engagements included differences in planning cycles between the government and donors, uncertainties in funding from the prime donors, lack of transparency, limited skills of district planning teams, technical practicalities on planning tools and processes, inadequate knowledge on planning guidelines among DPs and, poor donor coordination at the district level. Conclusions We found low engagement of Development Partners in planning. To be resolved are operational challenges related to differences in planning cycles, articulations and communication of local priorities, donor coordination, and technical skills on planning and stakeholder engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12520-6.
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Health System Resiliency and the COVID-19 Pandemic: A Case Study of a New Nationwide Contingency Staffing Program. Healthcare (Basel) 2022; 10:healthcare10020244. [PMID: 35206859 PMCID: PMC8872234 DOI: 10.3390/healthcare10020244] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/15/2022] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
When COVID-19 emerged, the U.S. Veterans Health Administration (VA) was in the process of implementing a national contingency staffing program called Clinical Resource Hubs (CRHs). CRHs were intended to provide regional contingency staffing for primary and mental health clinics experiencing staffing shortages primarily through telehealth. Long-term plans (year 2) included emergency management support. Early in the implementation, we conducted semi-structured interviews with CRH directors and national program leaders (n = 26) and used a rapid analysis approach to identify actions taken by CRHs to support the resiliency of the VA healthcare system during the pandemic. We found that the CRH program was flexible and nimble enough to allow VA to leverage providers at hubs to better respond to the demands of COVID-19. Actions taken at hubs to sustain patient access and staff resiliency during the pandemic included supporting call centers and training VA providers on virtual care delivery. Factors that facilitated CRH’s emergency response included hub staff expertise in telehealth and the increased acceptability of virtual care among key stakeholders. We conclude that hub providers serving as contingency staff, as well as specialization in delivering virtual outpatient and inpatient care, enabled VA health system resiliency and recovery during the COVID-19 pandemic.
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Bai Q, Ke X, Huang L, Liu L, Xue D, Bian Y. Finding flaws in the spatial distribution of health workforce and its influential factors: An empirical analysis based on Chinese provincial panel data, 2010-2019. Front Public Health 2022; 10:953695. [PMID: 36589992 PMCID: PMC9794860 DOI: 10.3389/fpubh.2022.953695] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Background The maldistributions of the health workforce showed great inconsistency when singly measured by population quantity or geographic area in China. Meanwhile, earlier studies mainly employed traditional econometric approaches to investigate determinants for the health workforce, which ignored spillover effects of influential factors on neighboring regions. Therefore, we aimed to analyze health workforce allocation in China from demographic and geographic perspectives simultaneously and then explore the spatial pattern and determinants for health workforce allocation taking account of the spillover effect. Methods The health resource density index (HRDI) equals the geometric mean of health resources per 1,000 persons and per square kilometer. First, the HRDI of licensed physicians (HRDI_P) and registered nurses (HRDI_N) was calculated for descriptive analysis. Then, global and local Moran's I indices were employed to explore the spatial features and aggregation clusters of the health workforce. Finally, four types of independent variables were selected: supportive resources (bed density and government health expenditure), healthcare need (proportion of the elderly population), socioeconomic factors (urbanization rate and GDP per capita), and sociocultural factors (education expenditure per pupil and park green area per capita), and then the spatial panel econometric model was used to assess direct associations and intra-region spillover effects between independent variables and HRDI_P and HRDI_N. Results Global Moran's I index of HRDI_P and HRDI_N increased from 0.2136 (P = 0.0070) to 0.2316 (P = 0.0050), and from 0.1645 (P = 0.0120) to 0.2022 (P = 0.0080), respectively. Local Moran's I suggested spatial aggregation clusters of HRDI_P and HRDI_N. For HRDI_P, bed density, government health expenditure, and GDP had significantly positive associations with local HRDI_P, while the proportion of the elderly population and education expenditure showed opposite spillover effects. More precisely, a 1% increase in the proportion of the elderly population would lead to a 0.4098% increase in HRDI_P of neighboring provinces, while a 1% increase in education expenditure leads to a 0.2688% decline in neighboring HRDI_P. For HRDI_N, the urbanization rate, bed density, and government health expenditure exerted significantly positive impacted local HRDI_N. In addition, the spillover effect was more evident in the urbanization rate, with a 1% increase in the urbanization rate relating to 0.9080% growth of HRDI_N of surrounding provinces. Negative spillover effects of education expenditure, government health expenditure, and elderly proportion were observed in neighboring HRDI_N. Conclusion There were substantial spatial disparities in health workforce distribution in China; moreover, the health workforce showed positive spatial agglomeration with a strengthening tendency in the last decade. In addition, supportive resources, healthcare needs, and socioeconomic and sociocultural factors would affect the health labor configuration not only in a given province but also in its nearby provinces.
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Affiliation(s)
- Qian Bai
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Xinyu Ke
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Lieyu Huang
- Office of Policy and Planning Research, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liming Liu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Dongmei Xue
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Ying Bian
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
- *Correspondence: Ying Bian
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Atobatele S, Omeje O, Ayodeji O, Oisagbai F, Sampson S. Situational Analysis of Access to Essential Healthcare Services in Nigeria: Implication for Trans-Sectorial Policy Considerations in Addressing Health Inequities. Health (London) 2022. [DOI: 10.4236/health.2022.145041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Description of a student success program to increase support, coping, and self-efficacy among under-represented minority nursing students in the wake of the dual pandemics of COVID-19 and racial violence. J Prof Nurs 2022; 43:42-52. [PMID: 36496243 PMCID: PMC9484985 DOI: 10.1016/j.profnurs.2022.09.006] [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: 01/23/2022] [Revised: 08/27/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Increasing the size and diversity of the nursing workforce is an important priority. Here, we describe a student success program to increase students' perceived support, coping, and self-efficacy for completing the nursing program among underrepresented racial/ethnic minority students in nursing education following the dual pandemics of COVID-19 and racial injustice. METHODS In collaboration with the Urban Health Program at the University of Illinois Chicago, we conducted a 15-week online student success pilot program with a volunteer sample of upper-level undergraduate nursing students. The curriculum for the program included topics centered on traditional student success topics and psychological, emotional, and contextual issues associated with student success. The sessions were conducted weekly throughout the Spring and Fall semesters of 2021, lasting 90-min. Quality improvement evaluations included weekly process variables and a post-test assessment. RESULTS Participants (N = 35) were primarily female and Hispanic. The program was acceptable, with participants very satisfied with the weekly sessions (83 %). Post-evaluations revealed self-reported improvements in peer support (69 %), confidence in reaching educational goals (94 %), handling microaggressions (77 %), coping with adversity (80 %), stress levels (63 %), and thoughts about leaving the program (86 %). CONCLUSIONS This student success program shows promise for improving general and minority-specific factors associated with student success. Additional development and evaluation are needed to determine the program's benefits for a larger group of nursing students.
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Bhattacharyya DS, Dutta GK, Nowrin I, Shafique S, Islam MZ, Riazul Islam BM, Anwar I. Implementing a digital human resources management tool in the government health sector in Bangladesh: a policy content analysis. BMC Health Serv Res 2021; 21:1346. [PMID: 34915886 PMCID: PMC8675532 DOI: 10.1186/s12913-021-07304-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In Bangladesh, to address the challenges of ensuring adequate human resources for health (HRH), the government began implementing a digital tool for HRH management in 2017. However, evidence suggests institutionalizing such tools in low-and-middle-income countries is impeded by policy aspects like implementation strategy and poor regulatory framework. Therefore, we aimed to explore factors in the current policy landscape that might facilitate and challenge the implementation of the tool in Bangladesh. METHODS We conducted a review of policies related to ICT implementation and human resources management in the health sector in Bangladesh using qualitative content analysis method. Ten policies have been identified, and extensive reading was done to ascertain common themes and patterns. A document analysis matrix was developed to synthesize and help interpret the findings. RESULTS Regarding facilitators, strong upstream level commitments were reflected in the content of policies in terms of setting out specific objectives, targets, timelines, and budget allocation. However, the lack of explicit monitoring strategy and extent of stakeholders' engagement was not well-defined, ultimately creating chances for impeding downstream implementation. In addition, effective coordination among stakeholders and different HRH and ICT policies could be strengthened. DISCUSSION Findings support the current discourse that national commitment plays a vital role in the integration of ICTs in health services. However, well-defined monitoring strategy and inter-ministry and intra-ministry policy coordination are crucial.
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Affiliation(s)
- Dipika Shankar Bhattacharyya
- Health Systems and Population Studies Division, icddr,b, 68, Shaheed Tajuddin Ahmed Ave, Mohakhali, Dhaka, Bangladesh.
| | - Goutam Kumar Dutta
- Health Systems and Population Studies Division, icddr,b, 68, Shaheed Tajuddin Ahmed Ave, Mohakhali, Dhaka, Bangladesh
| | - Iffat Nowrin
- Health Systems and Population Studies Division, icddr,b, 68, Shaheed Tajuddin Ahmed Ave, Mohakhali, Dhaka, Bangladesh
| | - Sohana Shafique
- Health Systems and Population Studies Division, icddr,b, 68, Shaheed Tajuddin Ahmed Ave, Mohakhali, Dhaka, Bangladesh
| | - Md Zahidul Islam
- Coordination and Support Centre, Directorate General of Health Services, Dhaka, Bangladesh
| | - B M Riazul Islam
- Coordination and Support Centre, Directorate General of Health Services, Dhaka, Bangladesh
| | - Iqbal Anwar
- Health Systems and Population Studies Division, icddr,b, 68, Shaheed Tajuddin Ahmed Ave, Mohakhali, Dhaka, Bangladesh
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