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Zalani GS, Shokri A, Mirbahaeddin E, Kashkalani T, Khalilnezhad R, Bayat M. Projection of Health Sector Workforce Requirement: Vision 2025. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1463-1473. [PMID: 34568186 PMCID: PMC8426765 DOI: 10.18502/ijph.v50i7.6637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/15/2020] [Indexed: 02/03/2023]
Abstract
Background: This study was conducted with a long-term vision (2014–2025) targeted workforce requirement projection by occupational groups in Iran’s health sector. Methods: The “modified & combined model” used including Hall Model and Australian health workforce estimation model. It was a need-based approach with three components of estimation; requirements, supply with current growth and net required workforce. Requirement estimated by three assumptions: active workforce calculation; the growth of health service delivery resources and facilities; and daily individual working hours, created eight different scenarios. Economic feasibility of each scenario determined. To forecast the supply, used accurate numbers of the existing pool of practicing workforce in addition to inflows, minus losses from the profession. To calculate total recruits required, base year stock deducted from projected requirement and by adding Net flow, recruits required calculated. Results: The health sector will need 781,887 workforces to realize service’s needs. Workforce supply with the existing trend in the target year was 799,347. Therefore, workforce balance would be 17,460 surpluses. Moreover, to estimate required workforce and substitution number for the exited ones during the study periods till the target year, 547,136 individuals should be recruited mostly nurses and physicians. Conclusion: Limiting the workforce required to economic feasibility challenge workforce accessibility in the future as it is sensed in present tense as well. Therefore, in addition augmenting GDP and health funds, it is necessary alternative policies such as increasing share of health sector from GDP, prioritization of workforce needs or moving towards other proper policies.
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Affiliation(s)
| | - Azad Shokri
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Tahereh Kashkalani
- Center for Health Human Resources Research & Studies, Ministry of Health and Medical Education, Tehran, Iran
| | - Roghayeh Khalilnezhad
- Center for Health Human Resources Research & Studies, Ministry of Health and Medical Education, Tehran, Iran.,Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Bayat
- Center for Health Human Resources Research & Studies, Ministry of Health and Medical Education, Tehran, Iran
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Pfeil JN, Rados DV, Roman R, Katz N, Nunes LN, Vigo Á, Harzheim E. A telemedicine strategy to reduce waiting lists and time to specialist care: A retrospective cohort study. J Telemed Telecare 2020; 29:10-17. [DOI: 10.1177/1357633x20963935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The demand for specialty care is rising worldwide. In the state of Rio Grande do Sul, Brazil, more than 150,000 people were waiting for specialist consultations in 2013. A telemedicine programme (RegulaSUS) developed referral protocols, audited waitlisted cases, authorised/prioritised referrals by risk and discuss deferred cases primary-care physician. This study assesses the effectiveness of RegulaSUS. Methods A retrospective cohort analysis with contemporaneous controls was performed from June 2014 to June 2016. Six medical specialties included in RegulaSUS (50,185 patients) were compared to 50,124 control patients waitlisted according to the usual routine (scheduled for specialty consultation at the next available date). The groups were matched (1:1) by semester and year of waitlisting and by the specialty demand-to-supply ratio. Primary outcomes were referral-to-consultation time and number of waitlisted patients. Results The mean referral-to-consultation time was 584.8 days in the intervention group and 607.0 days in controls ( p<0.001). For specialties regulated by RegulaSUS, the mean referral-to-consultation time was 237.6 days for higher-risk patients. At the end of the observation, 26,708 control patients had been unlisted compared to 31,050 patients in the intervention group (reduction of 53.5% vs. 61.9%, respectively; p<0.001). The number of cancelled referrals was lower in the control group ( n=14,403; 28.7%) than in the intervention group ( n=16,387; 32.7%; p<0.001). Discussion Telemedicine support for primary care effectively decreased the time to specialty consultation, reduced the number of waitlisted patients and allowed sicker patients to reach a specialist faster.
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Affiliation(s)
- Juliana N Pfeil
- Núcleo de Telessaúde Técnico Científico do Rio Grande do Sul (TelessaúdeRS-UFRGS), Porto Alegre, RS, Brazil
| | - Dimitris V Rados
- Núcleo de Telessaúde Técnico Científico do Rio Grande do Sul (TelessaúdeRS-UFRGS), Porto Alegre, RS, Brazil
| | - Rudi Roman
- Núcleo de Telessaúde Técnico Científico do Rio Grande do Sul (TelessaúdeRS-UFRGS), Porto Alegre, RS, Brazil
| | - Natan Katz
- Núcleo de Telessaúde Técnico Científico do Rio Grande do Sul (TelessaúdeRS-UFRGS), Porto Alegre, RS, Brazil
| | - Luciana N Nunes
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Álvaro Vigo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Erno Harzheim
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Montañez-Hernández JC, Alcalde-Rabanal J, Reyes-Morales H. Socioeconomic factors and inequality in the distribution of physicians and nurses in Mexico. Rev Saude Publica 2020; 54:58. [PMID: 32555978 PMCID: PMC7274212 DOI: 10.11606/s1518-8787.2020054002011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/30/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the human resources for health and analyze the inequality in its distribution in Mexico. METHODS Cross-sectional study based on the National Occupation and Employment Survey (ENOE in Spanish) for the fourth quarter of 2018 in Mexico. Graduated physicians and nurses, and auxiliary/technician nurses with completed studies were considered as human resources for health. States were grouped by degree of marginalization. Densities of human resources for health per 1,000 inhabitants, Index of Dissimilarity (DI) and Concentration Indices (CI) were estimated as measures of unequal distribution. RESULTS The density of human resources for health was 4.6 per 1,000 inhabitants. We found heterogeneity among states with densities from 2.3 to 10.5 per 1,000 inhabitants. Inequality was higher in the states with a very low degree of marginalization (CI = 0.4) than those with high marginalization (CI = 0.1), and the inequality in the distribution of physicians (CI = 0.5) was greater than in graduated nurses (CI = 0.3) among states. In addition, 17 states showed a density above the threshold of 4.5 per 1,000 inhabitants proposed in the Global Strategy on Human Resources for Health. That implies a deficit of nearly 60,000 human resources for health among the 15 states below the threshold. For all states, to reach a density equal to the national density of 4.6, about 12.6% of human health resources would have to be distributed among states that were below national density. CONCLUSIONS In Mexico, there is inequality in the distribution of human resources for health, with state differences. Government mechanisms could support the balance in the labor market of physicians and nurses through a human resources policy.
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Affiliation(s)
| | - Jacqueline Alcalde-Rabanal
- Instituto Nacional de Salud Pública, Centro de Investigación en Sistemas de Salud, Cuernavaca, Mor, México
| | - Hortensia Reyes-Morales
- Instituto Nacional de Salud Pública, Centro de Investigación en Sistemas de Salud, Cuernavaca, Mor, México
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The factors affecting the obstetricians-gynecologists workforce planning: A systematic review. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sriram V, Bennett S. Strengthening medical specialisation policy in low-income and middle-income countries. BMJ Glob Health 2020; 5:e002053. [PMID: 32133192 PMCID: PMC7042575 DOI: 10.1136/bmjgh-2019-002053] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/10/2019] [Accepted: 12/22/2019] [Indexed: 12/13/2022] Open
Abstract
The availability of medical specialists has accelerated in low-income and middle-income countries (LMICs), driven by factors including epidemiological and demographic shifts, doctors' preferences for postgraduate training, income growth and medical tourism. Yet, despite some policy efforts to increase access to specialists in rural health facilities and improve referral systems, many policy questions are still underaddressed or unaddressed in LMIC health sectors, including in the context of universal health coverage. Engaging with issues of specialisation may appear to be of secondary importance, compared with arguably more pressing concerns regarding primary care and the social determinants of health. However, we believe this to be a false choice. Policy at the intersection of essential health services and medical specialties is central to issues of access and equity, and failure to formulate policy in this regard may have adverse ramifications for the entire system. In this article, we describe three critical policy questions on medical specialties and health systems with the aim of provoking further analysis, discussion and policy formulation: (1) What types, and how many specialists to train? (2) How to link specialists' production and deployment to health systems strengthening and population health? (3) How to develop and strengthen institutions to steer specialisation policy? We posit that further analysis, discussion and policy formulation addressing these questions presents an important opportunity to explicitly determine and strengthen the linkages between specialists, health systems and health equity.
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Affiliation(s)
- Veena Sriram
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois, USA
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Pagaiya N, Phanthunane P, Bamrung A, Noree T, Kongweerakul K. Forecasting imbalances of human resources for health in the Thailand health service system: application of a health demand method. HUMAN RESOURCES FOR HEALTH 2019; 17:4. [PMID: 30621716 PMCID: PMC6325808 DOI: 10.1186/s12960-018-0336-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 12/03/2018] [Indexed: 05/30/2023]
Abstract
BACKGROUND For an effective health system, human resources for health (HRH) planning should be aligned with health system needs. To provide evidence-based information to support HRH plan and policy, we should develop strategies to quantify health workforce requirements and supply. The aim of this study is to project HRH requirements for the Thai health service system in 2026. HRH included in this study were doctors, dentists, nurses, pharmacists, medical technicians (MTs), physiotherapists (PTs), and Thai traditional medicine (TTM) practitioners. METHODS AND RESULTS The study mainly relied on the secondary data in relation to service utilization and population projection together with expert opinions. Health demand method was employed to forecast the HRH requirements based on the forecasted service utilizations. The results were then converted into HRH requirements using the staffing norm and productivity. The HRH supply projection was based on the stock and flow approach in which current stock and the flow in and out were taken into account in the projection. The results showed that in 2026, nurses are likely to be in critical shortages. The supply of doctors, pharmacists, and PTs is likely to be surplus. The HRH requirements are likely to match with the supply in cases of dentists, MTs, and TTM practitioners. CONCLUSION In 2026, the supply of key professionals is likely to be sufficient except nurses who will be in critical shortages. The health demand method, although facing some limitations, is useful to project HRH requirements in such a situation that people are accessible to health services and future service utilizations are closely linked to current utilization rates.
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Affiliation(s)
- Nonglak Pagaiya
- Faculty of Public Health, Khonkaen University, 123 Mitraphap road, Muang, Khonkaen, 40000 Thailand
| | | | - Adun Bamrung
- Khon Kaen Provincial Health Office, Muang, Khonkaen, 40000 Thailand
| | - Thinakorn Noree
- International Health Policy Program, Ministry of Public Health, Tiwanon road, Muang, Nonthaburi, 11000 Thailand
| | - Karnwarin Kongweerakul
- International Health Policy Program, Ministry of Public Health, Tiwanon road, Muang, Nonthaburi, 11000 Thailand
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Díaz-Portillo SP, Reyes-Morales H, Cuadra-Hernández SM, Idrovo ÁJ, Nigenda G, Dreser A. [Working conditions in outpatient clinics adjacent to private pharmacies in Mexico City: perspective of physicians]. GACETA SANITARIA 2017; 31:459-465. [PMID: 28473208 DOI: 10.1016/j.gaceta.2016.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. METHODS We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. RESULTS Respondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. CONCLUSIONS Physicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users.
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Affiliation(s)
- Sandra P Díaz-Portillo
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | | | | | - Álvaro J Idrovo
- Departamento de Salud Pública, Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - Gustavo Nigenda
- Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, México
| | - Anahí Dreser
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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