'Feminization' of physician workforce in Bangladesh, underlying factors and implications for health system: Insights from a mixed-methods study

Intensity of Interprofessional Collaboration and related factors in Intensive Care Units. A descriptive cross-sectional study with an analytical approach

OBJECTIVE

To determine the Intensity of Collaboration between the intensive care professionals of a third level hospital.

METHOD

Descriptive cross-sectional study with an analytical approach.

SETTING

6 intensive care units of a third level hospital.

SAMPLE

nurses and doctors. Consecutive type non-probabilistic sampling.

DATA COLLECTION

sociodemographic, economic, motivation and professional satisfaction variables, and the intensity of collaboration using the "Scale of Intensity of Interprofessional Collaboration in Health."

RESULTS

A total of 102 health professionals (91 nurses and 11 doctors) were included. The mean overall Intensity of Collaboration (IoC) was moderate. Men showed higher scores in all factors (p<.05). The IoC global score was higher in the group of professionals with ≤10 years of experience (p=.043) and those who were highly satisfied with the profession (p=.037). Physicians presented higher scores in the global IdC (p=.037) and in the Collaboration mean (p=.020) independently in the multivariate models. A negative linear relationship (rho: -0,202, p=.042) was observed between age and the overall IoC score. Professionals aged ≤30years reported a higher perception of Shared Activities (p=.031). Negative linear relationships were observed between years of experience and total IoC score (rho: -0,202, p=.042) and patients' Perception score (rho: -0.241, p=0.015). The research activity also showed to be a variable related to a greater degree of Collaboration at a global level and in some of the factors (p<.05). The scale of IoC obtained a Cronbach's α of 0,9.

CONCLUSIONS

The intensity of interprofessional collaboration in ICUs is moderate. Professionals with experience of ≤10 years, a higher level of satisfaction and participation in research activities show a greater intensity of collaboration. Doctors perceive collaboration more intensely than nurses. All factors contribute equally to the internal consistency of the questionnaire.

Feminization of the health workforce in China: exploring gendered composition from 2002 to 2020

BACKGROUND

Feminization of health workforce has been globally documented, but it has not been investigated in China. This study aims to analyze changes in the gendered composition of health workforce and explore the trend in different types of health workforce, health organizations and majors within China's health system.

METHODS

The data were collected from China Health Statistical Yearbook from 2002 to 2020. We focused on health professionals including doctors, nurses, and pharmacists in health organizations. Trend analysis was employed to examine the change in the ratio of female health workforce over 18 years. The estimated average annual percent change (AAPC) was estimated, and the reciprocals of variances for the female ratios were used as weights.

RESULTS

In China, health professionals increased from 4.7 million in 2002 to 10.68 million in 2020. Health professionals per 1000 population increased from 3.41 in 2002 to 7.57 in 2020. The ratio of female health professionals significantly increased from 63.85% in 2002 to 72.4% in 2020 (AAPC = 1.04%, 95% CI 0.96-1.11%, P < 0.001). Female doctors and pharmacists increased 4.7 and 7.9 percentage points from 2002 to 2020. Female health workers at township health centers, village clinics, centers for disease control and prevention had higher annual increase rate (AAPC = 1.67%, 2.25% and 1.33%, respectively) than those at hospital (0.70%) and community health center (0.5%). Female doctors in traditional Chinese medicine, dentistry and public health had higher annual increase rate (AAPC = 1.82%, 1.53% and 1.91%, respectively) than female clinical doctor (0.64%).

CONCLUSIONS

More women are participating in the healthcare sector in China. However, socially lower-ranked positions have been feminizing faster, which could be due to the inherent and structural gender norms restricting women's career. More collective and comprehensive system-level actions will be needed to foster a gender-equitable environment for health workforce at all levels.

Burnout risks in Bangladeshi Physicians: A multicenter, cross-sectional study

Physician burnout is a global concern that can lead to exhaustion, ineffectiveness, and poor health outcomes. Burnout has been linked to a variety of societal and professional variables worldwide. This cross-sectional, multi-centered study was conducted by face-to-face interviews between April 2019 and December 2021 at sixty-two (62) tertiary level hospitals to identify potential risk factors for burnout among Bangladeshi physicians, which is essential for preventing adverse impact on their well-being, improving overall quality of life, and facilitating measures to manage stress and maintain a healthy work-life balance. A simple random sampling technique in conjunction with a structured questionnaire was used to collect a total of 1434 responses, assuming 20 % of the sample as non-responsive. Univariate, bivariate, and multinomial logistic regression statistical analyses were performed to determine the risk factors and associate the level of severity. The distribution of burnout status differs significantly at distinct covariate levels, such as working place, working hour, prevalence of potential interpersonal conflicts (subsequent increase of adjusted odds ratios i.e.; 6.52, 8.82, 11.41, and 37.07 is observed for physicians having interpersonal conflicts with both co-workers & family members), job dissatisfaction, annoyed feeling while dealing with patients (adjusted odds ratios are 529.68, 518.26,983.87 and 849.57 respectively) and some other significant factors of the physicians. This study also reveals that the female physicians, physicians with age 40-49, physicians with additional liabilities, physicians with job dissatisfaction, less salary compared to the workload, less flexibility and security at the job sector as well as obese physicians are at high risk of burnout. These results are statistically significant with a p value ≤ 0.05. To reduce burnout of Bangladeshi physicians, it is necessary to address the risk factors, create supportive workplaces, maintain a healthy work-life balance, provide opportunities for self-care, and promote mental health.

The Role of National Specialist Societies in Influencing Transformational Change in Low-Middle Income Countries - Reflections on the Model of Implementation for a National Endoscopy Training Programme in Bangladesh

The British Society of Gastroenterology (BSG) and the Bangladesh Gastroenterology Society (BGS) have collaborated on an endoscopy training programme, which has grown up over the past decade from a small scheme borne out of the ideas of consultant gastroenterologists in Swansea, South Wales (United Kingdom) to improve gastroenterology services in Bangladesh to become a formalised training programme with broad reach. In this article, we document the socioeconomic and historical problems that beset Bangladesh, the current training needs of doctors and how the BSG-BGS collaboration has made inroads into changing outcomes both for gastroenterologists in Bangladesh, but also for the populations they serve.

Factors associated with increasing rural doctor supply in Asia-Pacific LMICs: a scoping review

BACKGROUND

More than 60% of the world's rural population live in the Asia-Pacific region. Of these, more than 90% reside in low- and middle-income countries (LMICs). Asia-Pacific LMICs rural populations are more impoverished and have poorer access to medical care, placing them at greater risk of poor health outcomes. Understanding factors associated with doctors working in rural areas is imperative in identifying effective strategies to improve rural medical workforce supply in Asia-Pacific LMICs.

METHOD

We performed a scoping review of peer-reviewed and grey literature from Asia-Pacific LMICs (1999 to 2019), searching major online databases and web-based resources. The literature was synthesized based on the World Health Organization Global Policy Recommendation categories for increasing access to rural health workers.

RESULT

Seventy-one articles from 12 LMICs were included. Most were about educational factors (82%), followed by personal and professional support (57%), financial incentives (45%), regulatory (20%), and health systems (13%). Rural background showed strong association with both rural preference and actual work in most studies. There was a paucity in literature on the effect of rural pathway in medical education such as rural-oriented curricula, rural clerkships and internship; however, when combined with other educational and regulatory interventions, they were effective. An additional area, atop of the WHO categories was identified, relating to health system factors, such as governance, health service organization and financing. Studies generally were of low quality-frequently overlooking potential confounding variables, such as respondents' demographic characteristics and career stage-and 39% did not clearly define 'rural'.

CONCLUSION

This review is consistent with, and extends, most of the existing evidence on effective strategies to recruit and retain rural doctors while specifically informing the range of evidence within the Asia-Pacific LMIC context. Evidence, though confined to 12 countries, is drawn from 20 years' research about a wide range of factors that can be targeted to strengthen strategies to increase rural medical workforce supply in Asia-Pacific LMICs. Multi-faceted approaches were evident, including selecting more students into medical school with a rural background, increasing public-funded universities, in combination with rural-focused education and rural scholarships, workplace and rural living support and ensuring an appropriately financed rural health system. The review identifies the need for more studies in a broader range of Asia-Pacific countries, which expand on all strategy areas, define rural clearly, use multivariate analyses, and test how various strategies relate to doctor's career stages.

Determinants of healthcare providers' confidence in their clinical skills to deliver quality obstetric and newborn care in Uganda and Zambia

Background

Poor quality obstetric and newborn care persists in sub-Saharan Africa and weak provider competence is an important contributor. To be competent, providers need to be both knowledgeable and confident in their ability to perform necessary clinical actions. Confidence or self-efficacy has not been extensively studied but may be related to individuals’ knowledge, ability to practice their skills, and other modifiable factors. In this study, we investigated how knowledge and scope of practice are associated with provider confidence in delivering obstetric and newborn health services in Uganda and Zambia.

Methods

This study was a secondary analysis of data from an obstetric and newborn care program implementation evaluation. Provider knowledge, scope of practice (completion of a series of obstetric tasks in the past 3 months) and confidence in delivering obstetric and newborn care were measured post intervention in intervention and comparison districts in Uganda and Zambia. We used multiple linear regression models to investigate the extent to which exposure to a wider range of clinical tasks associated with confidence, adjusting for facility and provider characteristics.

Results

Of the 574 providers included in the study, 69% were female, 24% were nurses, and 6% were doctors. The mean confidence score was 71%. Providers’ mean knowledge score was 56% and they reported performing 57% of basic obstetric tasks in the past 3 months. In the adjusted model, providers who completed more than 69% of the obstetric tasks reported a 13-percentage point (95% CI 0.08, 0.17) higher confidence than providers who performed less than 50% of the tasks. Female providers and nurses were considerably less confident than males and doctors. Provider knowledge was moderately associated with provider confidence.

Conclusions

Our study showed that scope of practice (the range of clinical tasks routinely performed by providers) is an important determinant of confidence. Ensuring that providers are exposed to a variety of services is crucial to support improvement in provider confidence and competence. Policies to improve provider confidence and pre-service training should also address differences by gender and by cadres.

Women Empowerment or Feminism: Facts and Myths about Feminization of Medical Education

  doi: https://doi.org/10.12669/pjms.36.3.2396 How to cite this:Baig LA. Women Empowerment or Feminism: Facts and Myths about Feminization of Medical Education. Pak J Med Sci. 2020;36(3):303-305. doi: https://doi.org/10.12669/pjms.36.3.2396 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Socio-economic characteristics and career intentions of the WiSDOM health professional cohort in South Africa

Background

The human resources for health (HRH) crisis and dearth of research on the health labour market in South Africa informed the WiSDOM (Wits longitudinal Study to Determine the Operation of the labour Market among its health professional graduates) cohort study. The study aims to generate new knowledge on the career choices and job location decisions of health professionals in South Africa.

Methods

WiSDOM is a prospective longitudinal cohort study. During 2017, the first cohort for each of eight professional groups was established: clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists and physiotherapists. These cohorts will be followed up for 15 years. For the baseline data collection, each final year health professional student completed an electronic self-administered questionnaire (SAQ), after providing informed consent. The SAQ included information on: demographic characteristics; financing of training; reasons for choosing their profession; and their career intentions. We used STATA^® 14 to analyse the data.

Results

We obtained an 89.5% response rate and 511 final year health professional students completed the baseline survey. The mean age of all participants was 24.1 years; 13.1% were born in a rural area; 11.9% and 8.0% completed their primary and secondary schooling in a rural area respectively. The health professional students came from relatively privileged backgrounds: 45.0% had attended a private school, the majority of their fathers (77.1%) had completed tertiary education, and 69.1% of their mothers had completed tertiary education. Students with higher socio-economic status (SES Quintiles 3–5) made up a larger proportion of the occupational therapists (77.8%), physiotherapists (71.7%), doctors (66.7%), and dentists (64.7%). In contrast, individuals from SES Quintiles 1 and 2 were over-represented among the clinical associates (75.0%), oral hygienists (71.4%), nurses (61.9%), and pharmacists (56.9%). Almost one quarter (24.9%) of cohort members indicated that they had partly financed their studies through loans. Although 86.3% of all cohort members indicated that they plan to stay in their chosen profession, this ranged from 43.2% for clinical associates to 100% for dentists.

Conclusions

WiSDOM has generated new knowledge on health professional graduates of a leading South African University. The results have implications for university selection criteria and national health workforce planning.

Feminisation of the health workforce and wage conditions of health professions: an exploratory analysis

BACKGROUND

The feminisation of the global health workforce presents a unique challenge for human resource policy and health sector reform which requires an explicit gender focus. Relatively little is known about changes in the gender composition of the health workforce and its impact on drivers of global health workforce dynamics such as wage conditions. In this article, we use a gender analysis to explore if the feminisation of the global health workforce leads to a deterioration of wage conditions in health.

METHODS

We performed an exploratory, time series analysis of gender disaggregated WageIndicator data. We explored global gender trends, wage gaps and wage conditions over time in selected health occupations. We analysed a sample of 25 countries over 9 years between 2006 and 2014, containing data from 970,894 individuals, with 79,633 participants working in health occupations (48,282 of which reported wage data). We reported by year, country income level and health occupation grouping.

RESULTS

The health workforce is feminising, particularly in lower- and upper-middle-income countries. This was associated with a wage gap for women of 26 to 36% less than men, which increased over time. In lower- and upper-middle-income countries, an increasing proportion of women in the health workforce was associated with an increasing gender wage gap and decreasing wage conditions. The gender wage gap was pronounced in both clinical and allied health professions and over lower-middle-, upper-middle- and high-income countries, although the largest gender wage gaps were seen in allied healthcare occupations in lower-middle-income countries.

CONCLUSION

These results, if a true reflection of the global health workforce, have significant implications for health policy and planning and highlight tensions between current, purely economic, framing of health workforce dynamics and the need for more extensive gender analysis. They also highlight the value of a more nuanced approach to health workforce planning that is gender sensitive, specific to countries' levels of development, and considers specific health occupations.