1
|
Kuhlmann E, Denis JL, Côté N, Lotta G, Neri S. Comparing Health Workforce Policy during a Major Global Health Crisis: A Critical Conceptual Debate and International Empirical Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5035. [PMID: 36981946 PMCID: PMC10049040 DOI: 10.3390/ijerph20065035] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The health workforce is central to healthcare systems and population health, but marginal in comparative health policy. This study aims to highlight the crucial relevance of the health workforce and contribute comparative evidence to help improve the protection of healthcare workers and prevention of inequalities during a major public health crisis. METHODS Our integrated governance framework considers system, sector, organizational and socio-cultural dimensions of health workforce policy. The COVID-19 pandemic serves as the policy field and Brazil, Canada, Italy, and Germany as illustrative cases. We draw on secondary sources (literature, document analysis, public statistics, reports) and country expert information with a focus on the first COVID-19 waves until the summer of 2021. RESULTS Our comparative investigation illustrates the benefits of a multi-level governance approach beyond health system typologies. In the selected countries, we found similar problems and governance gaps concerning increased workplace stress, lack of mental health support, and gender and racial inequalities. Health policy across countries failed to adequately respond to the needs of HCWs, thus exacerbating inequalities during a major global health crisis. CONCLUSIONS Comparative health workforce policy research may contribute new knowledge to improve health system resilience and population health during a crisis.
Collapse
Affiliation(s)
- Ellen Kuhlmann
- Clinic for Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30265 Hannover, Germany
- Sociology of Health and Health Systems, Faculty I, University of Siegen, Adolf-Reichwein-Strasse 1, 57068 Siegen, Germany
| | - Jean-Louis Denis
- Département de Gestion, D’évaluation et de Politique de Santé École de Santé Publique, Université de Montréal, C.P. 6128 Succursale A, Montréal, QC H3C 3J7, Canada
| | - Nancy Côté
- Département de Sociologie, Université Laval, Pavillon Charles-De Koninck, 1030, Avenue des Sciences-Humaines, Bureau 3469, Québec, QC G1V 0A6, Canada
| | - Gabriela Lotta
- Department of Public Administration, Getulio Vargas Foundation, Av Nove de Julho 2029, São Paulo 01313-902, Brazil
- Center of Metropolitan Studies, Cidade Universitária, 109, São Paulo 05508-060, Brazil
| | - Stefano Neri
- Department of Social and Political Sciences, University of Milan, Via Conservatorio 7, 20122 Milan, Italy
| |
Collapse
|
2
|
Kvalsund M, Birbeck GL, Herrmann DN. The peripheral view: Neuromuscular diagnosis, care and surveillance in global health. J Neurol Sci 2022; 432:120071. [PMID: 34862063 PMCID: PMC9210213 DOI: 10.1016/j.jns.2021.120071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/19/2021] [Indexed: 01/17/2023]
Affiliation(s)
- Michelle Kvalsund
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA,Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia, Nationalist Road, P.O. Box 50110, Lusaka, Zambia
| | - Gretchen L. Birbeck
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA,UTH Neurology Research Office, Nationalist Road, Paediatric Annex, PO Box UTH 11, Lusaka, Zambia
| | - David N. Herrmann
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA
| |
Collapse
|
3
|
Cerf ME. Quintile distribution of health resourcing in Africa. COGENT MEDICINE 2021. [DOI: 10.1080/2331205x.2021.1997161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Marlon E. Cerf
- Grants, Innovation and Product Development, South African Medical Research Council, Cape Town, South Africa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
| |
Collapse
|
4
|
Kuhlmann E, Brînzac MG, Burau V, Correia T, Ungureanu MI. Health workforce protection and preparedness during the COVID-19 pandemic: a tool for the rapid assessment of EU health systems. Eur J Public Health 2021; 31:iv14-iv20. [PMID: 34751366 PMCID: PMC8576297 DOI: 10.1093/eurpub/ckab152] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article is dedicated to the WHO International Year of Health and Care Workers in 2021 in recognition of their commitment during the COVID-19 pandemic. The study aims to strengthen health workforce preparedness, protection and ultimately resilience during a pandemic. We argue for a health system approach and introduce a tool for rapid comparative assessment based on integrated multi-level governance. We draw on secondary sources and expert information, including material from Denmark, Germany, Portugal and Romania. The results reveal similar developments across countries: action has been taken to improve physical protection, digitalization and prioritization of healthcare worker vaccination, whereas social and mental health support programmes were weak or missing. Developments were more diverse in relation to occupational and organizational preparedness: some ad-hoc transformations of work routines and tasks were observed in all countries, yet skill-mix innovation and collaboration were strongest in Demark and weak in Portugal and Romania. Major governance gaps exist in relation to education and health integration, surveillance, social and mental health support programmes, gendered issues of health workforce capacity and integration of migrant healthcare workers (HCW). There is a need to step up efforts and make health systems more accountable to the needs of HCW during global public health emergencies.
Collapse
Affiliation(s)
- Ellen Kuhlmann
- Clinic for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- Institute of Infection Control and Infectious Diseases, University Medical Centre, Georg August University, Göttingen, Germany
| | - Monica-Georgiana Brînzac
- Faculty of Political, Administrative and Communication Sciences, Department of Public Health, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Viola Burau
- Department of Political Science, University of Aarhus, Aarhus, Denmark
- Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Tiago Correia
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marius-Ionut Ungureanu
- Faculty of Political, Administrative and Communication Sciences, Department of Public Health, Babeș-Bolyai University, Cluj-Napoca, Romania
| |
Collapse
|
5
|
Kuhlmann E, Dussault G, Wismar M. Health labour markets and the 'human face' of the health workforce: resilience beyond the COVID-19 pandemic. Eur J Public Health 2020; 30:iv1-iv2. [PMID: 32949241 PMCID: PMC7526772 DOI: 10.1093/eurpub/ckaa122] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ellen Kuhlmann
- Clinic of Rheumatology and Immunology, Medical School Hannover, Hannover, Germany
- Institute of Epidemiology, Social Medicine and Health Systems Research, Medical School, Hannover, Germany
- Correspondence: Ellen Kuhlmann, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. E-mail:
| | - Gilles Dussault
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
| | - Matthias Wismar
- European Observatory on Health Systems and Policies, Brussels, Belgium
| |
Collapse
|
6
|
Kuhlmann E, Falkenbach M, Klasa K, Pavolini E, Ungureanu MI. Migrant carers in Europe in times of COVID-19: a call to action for European health workforce governance and a public health approach. Eur J Public Health 2020; 30:iv22-iv27. [PMID: 32894300 PMCID: PMC7499585 DOI: 10.1093/eurpub/ckaa126] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The present study explores the situation of migrant carers in long-term care (LTC) in European Union Member States and the disruptions caused by the COVID-19 pandemic from a public health perspective. The aim is to bring LTC migrant carers into health workforce research and highlight a need for trans-sectoral and European heath workforce governance. We apply an exploratory approach based on secondary sources, document analysis and expert information. A framework comprising four major dimensions was developed for data collection and analysis: LTC system, LTC health labour market, LTC labour migration policies and specific LTC migrant carer policies during the COVID-19 crisis March to May 2020. Material from Austria, Italy, Germany, Poland and Romania was included in the study. Results suggest that undersupply of carers coupled with cash benefits and a culture of family responsibility may result in high inflows of migrant carers, who are channelled in low-level positions or the informal care sector. COVID-19 made the fragile labour market arrangements of migrant carers visible, which may create new health risks for both the individual carer and the population. Two important policy recommendations are emerging: to include LTC migrant carers more systematically in public health and health workforce research and to develop European health workforce governance which connects health system needs, health labour markets and the individual migrant carers.
Collapse
Affiliation(s)
- Ellen Kuhlmann
- Clinic for Rheumatology and Immunology, Medical School Hannover, Hannover, Germany
- Institute of Epidemiology, Social Medicine and Health Systems Research, Medical School Hannover, Hannover, Germany
| | | | - Kasia Klasa
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Marius-Ionut Ungureanu
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babe-Bolyai University, Cluj-Napoca, Romania
| |
Collapse
|
7
|
Tumwine G, Palmieri J, Larsson M, Gummesson C, Okong P, Östergren PO, Agardh A. 'One-size doesn't fit all': Understanding healthcare practitioners' perceptions, attitudes and behaviours towards sexual and reproductive health and rights in low resource settings: An exploratory qualitative study. PLoS One 2020; 15:e0234658. [PMID: 32584840 PMCID: PMC7316327 DOI: 10.1371/journal.pone.0234658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/30/2020] [Indexed: 11/18/2022] Open
Abstract
Although progress has been made to improve access to sexual and reproductive health services globally in the past two decades, in many low-income countries, improvements have been slow. Discrimination against vulnerable groups and failure to address health inequities openly and comprehensively play a role in this stagnation. Healthcare practitioners are important actors who, often alone, decide who accesses services and how. This study explores how health care practitioners perceive sexual and reproductive health and rights (SRHR) and how background factors influence them during service delivery. Participants were a purposefully selected sample of health practitioners from five low income countries attending a training in at Lund University, Sweden. Semi-structured interviews and qualitative content analysis were used. Three themes emerged. The first theme, "one-size doesn't fit all' in SRHR" reflects health practitioners' perception of SRHR. Although they perceived rights as fundamental to sexual and reproductive health, exercising of these rights was perceived to be context-specific. The second theme, "aligning a pathway to service delivery", illustrates a reflective balancing act between their personal values and societal norms in service delivery, while the third theme, "health practitioners acting as gatekeepers", describes how this balancing act oscillates between enabling and blocking behaviours. The findings suggest that, even though health care practitioners perceive SRHR as fundamental rights, their preparedness to ensure that these rights were upheld in service delivery is influenced by personal values and society norms. This could lead to actions that enable or block service delivery.
Collapse
Affiliation(s)
- Gilbert Tumwine
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
- St. Francis Hospital Nsambya, Kampala, Uganda
| | - Jack Palmieri
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Markus Larsson
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Christina Gummesson
- Centre for Teaching and Learning, Faculty of Medicine, Lund University, Lund, Sweden
| | - Pius Okong
- Health Service Commission, Kampala, Uganda
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| |
Collapse
|
8
|
Cerf ME. Health worker resourcing to meet universal health coverage in Africa. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1693711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marlon E. Cerf
- Grants, Innovation and Product Development, South African Medical Research Council, Cape Town, South Africa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
| |
Collapse
|
9
|
Gunn V, Muntaner C, Ng E, Villeneuve M, Gea-Sanchez M, Chung H. Gender equality policies, nursing professionalization, and the nursing workforce: A cross-sectional, time-series analysis of 22 countries, 2000-2015. Int J Nurs Stud 2019; 99:103388. [PMID: 31493758 DOI: 10.1016/j.ijnurstu.2019.103388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/18/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Nursing professionalization has substantial benefits for patients, health care systems, and the nursing workforce. Currently, however, there is limited understanding of the macro-level factors, such as policies and other country-level determinants, influencing both the professionalization process and the supply of nursing human resources. OBJECTIVES Given the significance of gender to the development of nursing, a majority-female occupation, the purpose of this analysis was to investigate the relationship between gender regimes and gender equality policies, as macro-level determinants, and nursing professionalization indicators, in this case the regulated nurse and nurse graduate ratios. DESIGN This cross-sectional, time-series analysis covered 16 years, from 2000 to 2015, and included 22 high-income countries, members of the Organisation for Economic Co-operation and Development. We divided countries into three clusters, using the gender policy model developed by Korpi, as proxy for gender regimes. The countries were grouped as follows: (a) Traditional family - Austria, Belgium, France, Germany, Greece, Italy, Netherlands, Portugal, and Spain; (b) Market-oriented - Australia, Canada, Ireland, Japan, New Zealand, South Korea, Switzerland, United Kingdom, and the United States; and (c) Earner-carer - Denmark, Finland, Norway, and Sweden. METHODS We used fixed-effects linear regression models and ran Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction to examine the effect of gender equality policies on nursing professionalization indicators. Given the existence of missing observations, we devised and implemented a multiple imputation strategy, with the help of the Amelia II program. We gathered our data from open access secondary sources. RESULTS Both the regulated nurse and nurse graduate ratios had averages that differed across gender regimes, being the highest in Earner-carer regimes and the lowest in Traditional family ones. In addition, we identified a number of indicators of gender equality policy in education, the labour market, and politics that are predictive of the regulated nurse and nurse graduate ratios. CONCLUSION This study's findings could add to existing upstream advocacy efforts to strengthen nursing and the nursing workforce through healthy public policy. Given that the study consists of an international comparative analysis of nursing, it should be relevant to both national and global nursing communities.
Collapse
Affiliation(s)
- Virginia Gunn
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, M5T 1P8, Canada; Dalla Lana School of Public Health, Collaborative Specialization in Global Health, University of Toronto, Ontario, M5T 1P8, Canada.
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, M5T 1P8, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, M5T 1P8, Canada
| | - Edwin Ng
- School of Social Work, Renison University College, University of Waterloo, Ontario, N2L 3G1, Canada
| | - Michael Villeneuve
- Governance and Strategy, Canadian Nurses Association, Ottawa, K2P 1E2, Canada
| | - Montserrat Gea-Sanchez
- GESEC Group, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Catalunya, ES 25003, Spain; GRECS Group, Biomedical Research Institute of Lleida, Lleida, Spain
| | - Haejoo Chung
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, South Korea; School of Health Policy & Management, College of Health Sciences, Korea University, Seongbuk-gu, Seoul, KR 02841, South Korea
| |
Collapse
|