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Butala CB, Cave RNR, Fyfe J, Coleman PG, Yang GJ, Welburn SC. Impact of COVID-19 on the neglected tropical diseases: a scoping review. Infect Dis Poverty 2024; 13:55. [PMID: 39075616 DOI: 10.1186/s40249-024-01223-2] [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: 02/19/2024] [Accepted: 06/28/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND This study investigates the impact of the COVID-19 pandemic on the prevalence, management, and control of the neglected tropical diseases (NTDs) highlighting the current or prospective impact of COVID-19 on research and development funding for, and execution of, NTD programmes. This review was conducted to determine if, and how, NTDs were affected by COVID-19, and whether those effects will delay the elimination goals of the Sustainable Development goals. METHODS Using open-source available data from policy and documentation from official websites of the relevant stakeholders including but not limited to World Health Organization (WHO) documents and policies, government foreign aid documents, and the Policy Cures G-Finder reports, this scoping review explored ongoing challenges to supporting research and development (R&D) for the NTDs and in maintaining NTD control programs; examined the constraints posed for NTD management by the pandemic from disruptions to healthcare services, reduction of finance and explored the potential long-term implications and consequences for those poorer, neglected populations in low and middle income-countries (LMICs). This was done by a scoping review literature search, publications were subject to an initial practical screening step to ensure the most relevant publications were selected for full screening, with the focus on scoping the designated topic of the impact of COVID-19 on NTDs. We further undertook an evaluation of the socio-economic factors exacerbating the impact of COVID-19 on NTD burden. RESULTS Multiple disruptions and setbacks, likely to affect NTD programmes and progress towards their elimination targets were identified in this study. R&D funding for the NTDs and AIDs and TB has declined since the funding high point of 2019, and for malaria since the high point of 2018. Significant changes in allocation of R&D funding within the NTDs are observed post pandemic, likely because of prioritization among donors. Diseases for which the least R&D investment was reported in place, prior to the pandemic (mycetoma, taeniasis/cysticercosis, trachoma and Buruli ulcer) have been particularly impacted post pandemic. We identified specific NTDs including schistosomiasis, leprosy, and rabies that have been affected by the COVID-19 pandemic and disruptions caused to on ongoing NTD control and elimination programs. Pandemic restrictions disrupted essential medical supply manufacturing and distribution impacting immunization programs and hindered efforts to control the spread of infectious diseases. NTD programmes have experienced numerous setbacks including delays in mass drug administration programs (e.g. for schistosomiasis), cancelled or delayed vaccination programs (e.g. for rabies) and closure of testing facilities has resulted in reduced diagnosis, treatment, and disease elimination for all NTDs. Lockdowns and clinic closures causing disruption to essential healthcare services restricted NTD surveillance and treatment programs. Community fears around contracting COVID-19 exacerbated the constraints to service delivery. Disparities in global vaccine distribution have widened with LMICs facing limited access to vaccines and disruption to immunization programs. Finally, the pandemic has led to increased poverty with poor and marginalized communities, impacting nutrition, healthcare access and education all of which have long term implications for NTD management and control. CONCLUSIONS The COVID-19 pandemic profoundly impacted global health research and global health equity. Attention and funding were diverted from all sectors, significantly affecting research and development efforts set out in the World Health Organization's NTD elimination Roadmaps. Ongoing changes to funding, economic crises, logistics and supply chain disruptions as well as deepening poverty has put a strain on already weak healthcare systems and exacerbated LMIC healthcare challenges. In particular, the delays and constraints to NTD management and elimination programs will have long-reaching consequences highlighting the need for global cooperation and renewed investment to put the NTD roadmap back on track. Targets and milestones are unlikely to be met without significant investment for recovery, in place.
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Affiliation(s)
- Caitlin Brigid Butala
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh, EH8 9TB, Scotland, UK
- Zhejiang University - University of Edinburgh Institute: Biomedicine, Zhejiang University School of Medicine, 718 East Haizhou Road, Haining, 314400, People's Republic of China
| | - Roo Nicola Rose Cave
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh, EH8 9TB, Scotland, UK
| | - Jenna Fyfe
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh, EH8 9TB, Scotland, UK
| | - Paul Gerard Coleman
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh, EH8 9TB, Scotland, UK
| | - Guo-Jing Yang
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, The School of Tropical Medicine, The First Affiliated Hospital, Hainan Medical University, Haikou, 571199, Hainan, People's Republic of China
| | - Susan Christina Welburn
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh, EH8 9TB, Scotland, UK.
- Zhejiang University - University of Edinburgh Institute: Biomedicine, Zhejiang University School of Medicine, 718 East Haizhou Road, Haining, 314400, People's Republic of China.
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, The School of Tropical Medicine, The First Affiliated Hospital, Hainan Medical University, Haikou, 571199, Hainan, People's Republic of China.
- School of Global Health, Chinese Centre for Global Tropical Disease Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
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Molla F, Molla M, Delle E, Asrade G, Endalew B. Intention to leave and associated factors among health professionals working at public hospitals in East Gojjam zone, Northwest Ethiopia, cross-sectional study. PLoS One 2024; 19:e0301235. [PMID: 38527050 PMCID: PMC10962794 DOI: 10.1371/journal.pone.0301235] [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: 03/24/2021] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The most important element of health systems for meeting the population's healthcare demands is the workforce. The main issue facing the health industry, particularly in emerging nations, has been their shortage and turnover. Thus, the purpose of this study was to assess the intention of leaving and related variables among medical professionals employed at East Gojjam zone public health hospitals. METHODS An institution based cross-sectional study was conducted among 561 randomly selected health professionals working at public hospitals in East Gojjam Zone from 04 March 2019 to 30 March 2019. Self-administered structured questionnaire was used for data collection. Both bi-variable and multivariable logistic regression analysis were fitted. Variables having P-value less than 0.2 during bi-variable regressional analysis were entered in to multivariable logistic regression analysis and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) was used to declare the associated factors with intention to leave. RESULTS Overall, 61.3% (95% CI: 57.2, 65.4) of health professionals were intended to leave their working organizations. Dissatisfaction with work nature (AOR: 3.01; 95% CI: 2.05, 4.43), work environment (AOR: 1.83, 95% CI: 1.25, 2.68), Remuneration (AOR: 1.89; 95% CI: 1.29, 2.76), having low normative commitment (AOR: 0.55; 95% CI: 0.38, 0.81) and being unmarried (AOR: 1.78; 95% CI: 1.23, 2.58) were satistically significant factors with intention to leave their working organizations. CONCLUSIONS The health professionals' intention to leave their working organizations was high, three-fifth of the health professionals had intention to leave their organization which might result great service quality compromization and decrease the responsiveness of the health institutions in the study area. Dissatisfaction with remuneration, working environment, work nature, low normative commitment and being unmarried were factors associated with health professional's intention to leave their working organizations. Therefore, hospital administrators, supervisors, and Healthcare policymakers need to emphasize on retention of health workers at their working organization by taking into account the above significant variables. Such as, through creating an attractive working environment and designing better benefit mechanisms.
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Affiliation(s)
- Friehiwot Molla
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Muluye Molla
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Endalkachew Delle
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Geta Asrade
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bekalu Endalew
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Mengstie MM, Biks GA, Cherlin EJ, Curry LA. Organizational culture and barriers to change in University of Gondar Comprehensive Specialized Hospital Cardiac Unit. BMC Health Serv Res 2023; 23:296. [PMID: 36978055 PMCID: PMC10053860 DOI: 10.1186/s12913-023-09278-x] [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: 12/16/2022] [Accepted: 03/11/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Cardiovascular disease is a major contributor to high mortality in Ethiopia. Hospital organizational culture affects patient outcomes including mortality rates for patients with cardiovascular disease. Therefore, the purpose of this study was to assess organizational culture and determine barriers to change in the Cardiac Unit of University of Gondar Comprehensive Specialized Hospital. METHODS We used a mixed methods approach with a sequential explanatory design. We collected data through a survey adapted from a validated instrument measuring organizational culture (n = 78) and in-depth interviews (n = 10) with key informants from different specialty areas. We analyzed the quantitative data using descriptive statistics and the qualitative data through a constant comparative method of thematic analysis. We integrated the data during the interpretation phase to generate a comprehensive understanding of the culture within the Cardiac Unit. RESULTS The quantitative results indicated poor psychological safety and learning and problem solving aspects of culture. On the other hand, there were high levels of organizational commitment and adequate time for improvement. The qualitative results also indicated resistance to change among employees working in the Cardiac Unit as well as other barriers to organizational culture change. CONCLUSION Most aspects of the Cardiac Unit culture were poor or weak, signaling opportunities to improve culture through identifying culture changing needs, implying the need to be aware of the subcultures within the hospitals that influence performance. Thus, it is important to consider hospital culture in planning health policy, strategies, and guidelines. RECOMMENDATIONS It is of paramount importance to strengthen organizational culture through fostering a safe space that enables workers to express divergent views and actively considering such views to improve the quality of care, supporting multidisciplinary teams to think creatively to address problems, and investing in data collection to monitor changes in practice and patient outcomes.
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Affiliation(s)
- Missaye M Mengstie
- Department of Psychology, College of Social Sciences and the Humanities, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
| | - Gashaw A Biks
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Emily J Cherlin
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA
| | - Leslie A Curry
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA
- Yale School of Management, New Haven, CT, USA
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Schuetze L, Srivastava S, Kuunibe N, Rwezaula EJ, Missenye A, Stoermer M, De Allegri M. What Factors Explain Low Adoption of Digital Technologies for Health Financing in an Insurance Setting? Novel Evidence From a Quantitative Panel Study on IMIS in Tanzania. Int J Health Policy Manag 2023; 12:6896. [PMID: 37579470 PMCID: PMC10125074 DOI: 10.34172/ijhpm.2023.6896] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Digital information management systems for health financing are implemented on the assumption thatdigitalization, among other things, enables strategic purchasing. However, little is known about the extent to which thesesystems are adopted as planned to achieve desired results. This study assesses the levels of, and the factors associated withthe adoption of the Insurance Management Information System (IMIS) by healthcare providers in Tanzania. METHODS Combining multiple data sources, we estimated IMIS adoption levels for 365 first-line health facilities in2017 by comparing IMIS claim data (verified claims) with the number of expected claims. We defined adoption as abinary outcome capturing underreporting (verified RESULTS We found a median (interquartile range [IQR]) difference of 77.8% (32.7-100) between expected and verifiedclaims, showing a consistent pattern of underreporting across districts, regions, and months. Levels of underreportingvaried across regions (ANOVA: F=7.24, P<.001) and districts (ANOVA: F=4.65, P<.001). Logistic regression resultsshowed that higher service volume, share of people insured, and greater distance to district headquarter were associatedwith a higher probability of underreporting. CONCLUSION Our study shows that the adoption of IMIS in Tanzania may be sub-optimal and far from policy-makers'expectations, limiting its capacity to provide the necessary information to enhance strategic purchasing in the healthsector. Countries and agencies adopting digital interventions such as openIMIS to foster health financing reform areadvised to closely track their implementation efforts to make sure the data they rely on is accurate. Further, our studysuggests organizational and infrastructural barriers beyond the software itself hamper effective adoption.
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Affiliation(s)
- Leon Schuetze
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Siddharth Srivastava
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Naasegnibe Kuunibe
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Faculty of Integrated Development Studies, University for Development Studies, Wa, Ghana
| | | | | | - Manfred Stoermer
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
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Schuetze L, Srivastava S, Missenye AM, Rwezaula EJ, Stoermer M, De Allegri M. Factors Affecting the Successful Implementation of a Digital Intervention for Health Financing in a Low-Resource Setting at Scale: Semistructured Interview Study With Health Care Workers and Management Staff. J Med Internet Res 2023; 25:e38818. [PMID: 36607708 PMCID: PMC9862332 DOI: 10.2196/38818] [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: 05/01/2022] [Revised: 10/01/2022] [Accepted: 10/31/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Digital interventions for health financing, if implemented at scale, have the potential to improve health system performance by reducing transaction costs and improving data-driven decision-making. However, many interventions never reach sustainability, and evidence on success factors for scale is scarce. The Insurance Management Information System (IMIS) is a digital intervention for health financing, designed to manage an insurance scheme and already implemented on a national scale in Tanzania. A previous study found that the IMIS claim function was poorly adopted by health care workers (HCWs), questioning its potential to enable strategic purchasing and succeed at scale. OBJECTIVE This study aimed to understand why the adoption of the IMIS claim function by HCWs remained low in Tanzania and to assess implications for use at scale. METHODS We conducted 21 semistructured interviews with HCWs and management staff in 4 districts where IMIS was first implemented. We sampled respondents by using a maximum variation strategy. We used the framework method for data analysis, applying a combination of inductive and deductive coding to organize codes in a socioecological model. Finally, we related emerging themes to a framework for digital health interventions for scale. RESULTS Respondents appreciated IMIS's intrinsic software characteristics and technical factors and acknowledged IMIS as a valuable tool to simplify claim management. Human factors, extrinsic ecosystem, and health care ecosystem were considered as barriers to widespread adoption. CONCLUSIONS Digital interventions for health financing, such as IMIS, may have the potential for scale if careful consideration is given to the environment in which they are placed. Without a sustainable health financing environment, sufficient infrastructure, and human capacity, they cannot unfold their full potential to improve health financing functions and ultimately contribute to universal health coverage.
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Affiliation(s)
- Leon Schuetze
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Siddharth Srivastava
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Manfred Stoermer
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
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Vergnolle G, Lahrichi N. Data-Driven Analysis of Employee Churn in the Home Care Industry. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221137354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Annual turnover of home care workers represents a huge loss of revenue and is a key source of inefficiency in the home health care industry. In this article, we propose a data-driven approach to monitor employee churn and to capture the evolution of employee intent to leave. Unlike most papers in the literature, we use machine learning techniques to analyze over 2 million visits in the US, Canada, and Australia between 2016 and 2019. Results show that the gap between the number of hours worked and in the contract is the most important factor to predict employee intent to leave, which means an employee should be given as many hours as requested in the contract to improve retention. Secondary results show that having diverse shift lengths and continuity in services and patients seem to be associated with less turnover.
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Rabie S, Laurenzi CA, Field S, Skeen S, Honikman S. A mixed-methods feasibility study of Nyamekela4Care: An intervention to support improved quality of care among service providers in low-resource settings. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gile PP, van de Klundert J, Buljac-Samardzic M. Strategic human resource management and performance in public hospitals in Ethiopia. Front Public Health 2022; 10:915317. [PMID: 36339178 PMCID: PMC9632433 DOI: 10.3389/fpubh.2022.915317] [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: 05/26/2022] [Accepted: 10/06/2022] [Indexed: 01/22/2023] Open
Abstract
Background Ethiopian public hospitals struggle to meet health care needs of the Ethiopian population, in part because of the persistent human resources crisis. The health reforms and tight human resource management (HRM) regulation of the government have resulted in limited progress toward addressing this crisis. This study aims to analyze how the strategic HRM practices adopted by Ethiopian public hospitals influence employee outcomes, organizational outcomes, and patient outcomes. Methods Structured interviews were conducted with 19 CEOs and HR managers from 15 hospitals. Four focus groups were also conducted, with 38 participants (professionals and line managers). The transcripts were thematically analyzed using ATLAS.ti 8. Deductive coding was used based on the Contextual SHRM framework, while remaining open for codes that emerged. Results Intended HR practices are influenced by mandatory strict government regulations. Nevertheless, some room for self-selected (bundles of) HR practices is perceived by hospitals. Employees perceive that governmental steered HR practices may not match its intentions due to implementation issues, related to lack of support and skilled management and HR professionals. These problems are leading to dissatisfaction, demotivation, moonlighting and turnover of skilled professionals and perceived to consequently negatively influence performance (i.e., patient satisfaction and waiting time). Conclusions There are considerable contextual challenges for SHRM in Ethiopian public hospitals. Hospital management can benefit from having more leeway and from exploiting it more effectively to improve actual and perceived strategic human resource management practices. Adoption of commitment based practices, in addition to mandatory control oriented practices can help to motivate and retain health care professionals and consequently improve outcomes.
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Affiliation(s)
- Philipos Petros Gile
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands,Higher Education Institutions' Partnership, Addis Ababa, Ethiopia,*Correspondence: Philipos Petros Gile
| | - Joris van de Klundert
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands,School of Business, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| | - Martina Buljac-Samardzic
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Gile PP, van de Klundert J, Buljac-Samardzic M. Human resource management in Ethiopian public hospitals. BMC Health Serv Res 2022; 22:763. [PMID: 35689209 PMCID: PMC9188153 DOI: 10.1186/s12913-022-08046-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background In Ethiopia, public hospitals deal with a persistent human resource crisis, even by Sub-Saharan Africa (SSA) standards. Policy and hospital reforms, however, have thus far resulted in limited progress towards addressing the strategic human resource management (SHRM) challenges Ethiopia’s public hospitals face. Methods To explore the contextual factors influencing these SHRM challenges of Ethiopian public hospitals, we conducted a qualitative study based on the Contextual SHRM framework of Paauwe. A total of 19 structured interviews were conducted with Chief Executive Officers (CEOs) and HR managers from a purposive sample of 15 hospitals across Ethiopia. An additional four focus groups were held with professionals and managers. Results The study found that hospitals compete on the supply side for scarce resources, including skilled professionals. There was little reporting on demand-side competition for health services provided, service quality, and service innovation. Governmental regulations were the main institutional mechanism in place. These regulations also emphasized human resources and were perceived to tightly regulate employee numbers, salaries, and employment arrangements at detailed levels. These regulations were perceived to restrict the autonomy of hospitals regarding SHRM. Regulation-induced differences in allowances and external employment arrangements were among the concerns that decreased motivation and job satisfaction and caused employees to leave. The mismatch between regulation and workforce demands posed challenges for leadership and caused leaders to be perceived as incompetent and unable when they could not successfully address workforce needs. Conclusions Bottom-up involvement in SHRM may help resolve the aforementioned persistent problems. The Ethiopian government might better loosen regulations and provide more autonomy to hospitals to develop SHRM and implement mechanisms that emphasize the quality of the health services demanded rather than the quantity of human resources supplied. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08046-7.
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Affiliation(s)
- Philipos Petros Gile
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands and Higher Education Institutions' Partnership, CMC Road, PO Box 14051, Addis Ababa, Ethiopia.
| | - Joris van de Klundert
- Prince Mohammad Bin Salman College (MBSC) of Business and Entrepreneurship, 7082-BayLaSun-Juman St. Unit No. 1, King Abdullah Economic City, 23964-2522, Saudi Arabia, Kingdom of Saudi Arabia.,Erasmus University Rotterdam, Erasmus School of Health Policy and Management, PO Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Martina Buljac-Samardzic
- Erasmus University Rotterdam, Erasmus School of Health Policy and Management, PO Box 1738, 3000, DR, Rotterdam, The Netherlands
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Zaman S, Ansari AH, Chaturvedi S. Work-life enablers for job satisfaction in healthcare: moderating role of organization type. INDUSTRIAL AND COMMERCIAL TRAINING 2021. [DOI: 10.1108/ict-05-2020-0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to examine how the quality of work-life (QWL) factors influence job satisfaction and tests if organization type moderates this relationship.
Design/methodology/approach
The study adopts a quantitative cross-sectional research design using survey administration among resident doctors used in the Indian health-care sector. Drawing on the person-environment fit theory, leader-member exchange theory and action learning theory, the authors discuss the results.
Findings
Results depicted that in addition to the direct relationship between QWL and job satisfaction, this association is moderated by organization type.
Practical implications
The study provides critical information for health-care managers to prioritize three QWL attributes, namely, meaningful development, supervision, working conditions to enhance job satisfaction among resident doctors.
Originality/value
The study contributes to the limited empirical scholarly research adding a deeper understanding of pertinent factors influencing resident doctor’s QWL-job satisfaction relationship.
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Ebenso B, Mbachu C, Etiaba E, Huss R, Manzano A, Onwujekwe O, Uzochukwu B, Ezumah N, Ensor T, Hicks JP, Mirzoev T. Which mechanisms explain motivation the of primary health workers? Insights from the realist evaluation of a maternal and child health programme in Nigeria. BMJ Glob Health 2020; 5:e002408. [PMID: 32843524 PMCID: PMC7449364 DOI: 10.1136/bmjgh-2020-002408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Well-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage (UHC). While there is abundant literature on the drivers of workforce motivation, published knowledge on the mechanisms of motivation within different contexts is limited, particularly in resource-limited countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria. METHODS We adopted a realist evaluation design combining document review with 56 in-depth interviews of PHC workers, facility managers and policy-makers to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers' motivation and which mechanisms explain how motivation works. We drew on Herzberg's two-factor and Adam's equity theories to unpack how context shapes worker motivation. RESULTS A complex and dynamic interaction between the MCH programme and organisational and wider contexts triggered five mechanisms which explain PHC worker motivation: (1) feeling supported, (2) feeling comfortable with work environment, (3) feeling valued, (4) morale and confidence to perform tasks and (5) companionship. Some mechanisms were mutually reinforcing while others operated in parallel. Other conditions that enabled worker motivation were organisational values of fairness, recognition of workers' contributions and culture of task-sharing and teamwork. CONCLUSIONS Policy designs and management strategies for improving workforce performance, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery and promote UHC. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC workers to inform cadre-related motivational interventions.
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Affiliation(s)
- Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds School of Medicine, Leeds, UK
| | - Chinyere Mbachu
- Health Policy Research Group, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Enyi Etiaba
- Health Policy Research Group, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Reinhard Huss
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ana Manzano
- Sociology & Social Policy, University of Leeds School of Sociology and Social Policy, Leeds, UK
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Benjamin Uzochukwu
- Health Policy Research Group, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Nkoli Ezumah
- Faculty of Social Sciences, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Timothy Ensor
- Nuffield Centre for International Health and Development, University of Leeds School of Medicine, Leeds, UK
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds School of Medicine, Leeds, UK
| | - Tolib Mirzoev
- Nuffield Centre for International Health and Development, University of Leeds School of Medicine, Leeds, UK
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Ogbuabor DC, Okoronkwo IL. The influence of quality of work life on motivation and retention of local government tuberculosis control programme supervisors in South-eastern Nigeria. PLoS One 2019; 14:e0220292. [PMID: 31339944 PMCID: PMC6655736 DOI: 10.1371/journal.pone.0220292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 07/12/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Significant gap exists in knowledge about employee-centred human resources practices that address motivation and retention of local government tuberculosis control programme supervisors (LGTBS) in Nigeria. The study examined the role of quality of worklife (QWL) in motivating and retaining LGTBS. Materials and methods The study was conducted in south-eastern region of Nigeria comprising five states and 95 local government areas. The design was mixed-methods. We used cross-sectional survey to collect quantitative data on socio-demographic factors, QWL, motivation and retention from a total sample of LGTBS. The qualitative component involved focus group discussions (n = 3) with 26 LGTBS. Quantitative data were analysed using exploratory factor analysis, descriptive statistics, Spearman correlation, Mann-Whitney test, Kruskal-Wallis test and multiple linear regression. Qualitative data were analysed using a thematic framework approach. Results The final 40-item QWL scale was found to be valid and reliable. The LGTBS had high QWL (M = 5.15, SD = 0.88) and motivation (M = 5.92, SD = 1.08), but low intention to leave their jobs (M = 2.68, SD = 1.59). Education significantly predicted satisfaction with overall QWL, work-family balance and work design; but tenure predicted satisfaction with work context. Work design and work-family balance significantly predicted motivation of LGTBS. Motivation mediated the relationship between QWL and intention to leave and accounted for 29% variance in intention to leave. Whereas LGTBS were motivated by responsibility, learning opportunities, achievement and recognition; they were dissatisfied with lack of flexible work schedules, involvement in non-TB tasks, long hours at work, limited opportunities for vacation, resource inadequacy, work-related stigma, lack of promotional opportunities, and pay disparity and delay. Conclusion Addressing work design, work-family balance and working conditions may increase the motivation and retention of LGTBS and improve human resources for TB at the district level and performance of the TB control programme.
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Affiliation(s)
- Daniel Chukwuemeka Ogbuabor
- Department of Health Systems and Policy, Sustainable Impact Resource Agency, Enugu, Enugu State, Nigeria
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria
- * E-mail:
| | - Ijeoma Lewechi Okoronkwo
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria
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Munar W, Wahid SS, Curry L. Characterizing performance improvement in primary care systems in Mesoamerica: A realist evaluation protocol. Gates Open Res 2018. [DOI: 10.12688/gatesopenres.12782.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Evaluations of performance measurement and management interventions in public, primary care delivery systems of low- and middle-income countries are scarce. In such contexts, few studies to date have focused on characterizing how, why and under what contextual conditions do such complex, multifaceted arrangements lead to intended and unintended consequences for the healthcare workforce, the healthcare organizations involved, and the communities that are served. Methods. Case-study design with purposeful outlier sampling of high-performing primary care delivery systems in El Salvador and Honduras, as part of the Salud Mesoamerica Initiative. Case study design is suitable for characterizing individual, interpersonal and collective mechanisms of change in complex adaptive systems. The protocol design includes literature review, document review, non-participant observation, and qualitative analysis of in-depth interviews. Data analysis will use inductive and deductive approaches to identify causal patterns organized as ‘context-mechanism-outcome’ configurations. Findings will be triangulated with existing secondary data sources collected including country-specific performance measurement data, impact, and process evaluations conducted by the Salud Mesoamerica Initiative. Discussion. This realist evaluation protocol aims to characterize how, why and under what conditions do performance measurement and management arrangements contribute to the improvement of primary care system performance in two low-income countries.
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