Forecast of Healthcare Facilities and Health Workforce Requirements for the Public Sector in Ghana, 2016-2026

The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review

Background

Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income countries (LMIC) are plagued with persistent underfunding, and recent reductions in official development assistance have been registered. To create fiscal space for health, the pursuit of efficiency gains and exploring innovative health financing for health seem attractive. This paper sought to synthesize available evidence on the nature of innovative health financing instruments, mechanisms and policies implemented in Africa. We further reviewed the factors that hinder or facilitate implementation, the lessons learnt on the structure, the development process and the implementation.

Methods

We conducted a systematic scoping review of the literature to analyze the nature, type, and factors impacting the implementation of innovative health financing mechanisms in the World Health Organization (WHO) African region.

Results

Innovative health financing mechanisms are increasing in the WHO African region as a result of international policy, the need to improve healthy eating and social life of the populace, advocacy and the availability of international mechanisms to which countries can subscribe. The 41 documents included in this review reported ten innovative financing mechanisms in 43 out of the 47 WHO Africa region member states. The most common mechanisms include an excise tax on tobacco products (43 countries) and alcoholic beverages and spirits (41 countries), airline ticket levy (18 countries), sugar-based beverages tax (seven countries), and levy on oil, gas and mineral tax (four countries). Other mechanisms include the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) trust fund, the social impact bond, the financial transaction tax, mobile phone tax and equity funds. Funds generated from many mechanisms are not allocated to health, although some portions are allocated to health-related activities. In some countries where mechanisms implemented are public health-related, emphasis is placed on positive health behavior beyond raising funds. Persistent resistance from industries due to conflicting economic policies is a major challenge.

Conclusions

Leveraging international policies and setting up intersectoral committees to develop and implement innovative mechanisms that involve excise taxes are recommended as possible solutions to the conflicts of interest.

Development and psychometric validation of the hospitalized older adults' dignity scale for measuring dignity during acute hospitalization

AIM

To develop and validate a culturally appropriate patient-reported outcome measure for measuring dignity for older adults during acute hospitalization.

DESIGN

A three-phased exploratory sequential mixed-method design was used.

METHODS

Domains were identified and items were generated from findings of a recent qualitative study, two systematic reviews and grey literature. Content validity evaluation and pre-testing were undertaken using standard instrument development techniques. Two-hundred and seventy hospitalized older adults were surveyed to test construct and convergent validity, internal consistency reliability and test-retest reliability of the measure. Analysis was performed using Statistical Package for the Social Sciences, version 25. The STROBE checklist was used to document reporting of the study.

RESULTS

We established the 15-item Hospitalized Older Adults' Dignity Scale (HOADS) that has a 5-factor structure: shared decision-making (3 items); healthcare professional-patient communication (3 items); patient autonomy (4 items); patient privacy (2 items); respectful care (3 items). Excellent content validity, adequate construct and convergent validity, acceptable internal consistency reliability and good test-retest reliability were demonstrated.

CONCLUSION

We established the HOADS is a valid and reliable scale to measure dignity for older adults during acute hospitalization. Future studies using confirmatory factor analysis are needed to corroborate the dimensionality of the factor structure and external validity of the scale. Routine use of the scale may inform the development of strategies to improve dignity-related care in the future.

IMPACT

The development and validation of the HOADS will provide nurses and other healthcare professionals with a feasible and reliable scale for measuring older adults' dignity during acute hospitalization. The HOADS advances the conceptual understanding of dignity in hospitalized older adults by including additional constructs that have not been captured in previous dignity-related measures for older adults (i.e. shared decision-making and respectful care). The factor structure of the HOADS, therefore, includes five domains of dignity and offers a new opportunity for nurses and other healthcare professionals to better understand the nuances of dignity for older adults during acute hospitalization. For example, the HOADS enables nurses to identify differences in levels of dignity based on contextual factors and to use this information to guide the implementation of strategies that promote dignified care.

PATIENT OR PUBLIC CONTRIBUTION

Patients were involved in the generation of items for the scale. Their perspectives and the perspectives of experts were sought in determining the relevance of each item of the scale to patients' dignity.

Patient dignity and dignified care: A qualitative description of hospitalised older adults perspectives

AIMS AND OBJECTIVES

The aim of this study was to explore older adults' perspectives about dignity and dignified nursing care during acute hospitalisation in Ghana.

BACKGROUND

Maintaining hospitalised older adults' dignity is an essential component of nursing care and one of the most important determinants of wellbeing. To date, no study has been published on older adults' perspectives of dignified nursing care in the African context.

STUDY DESIGN

A qualitative descriptive research design.

METHODS

Twenty hospitalised older adults were purposively selected from the medical and surgical wards of a teaching hospital in Ghana. Data were gathered through semi-structured interviews between April and August, 2021, and analysed using reflexive thematic analysis techniques. The SRQR checklist was used to document reporting of the study.

RESULTS

The following four themes were identified: Effective nurse-patient communication, Maintaining patients' privacy, Respectful and compassionate care provision and Providing quality and safe care. Dignity was preserved when patients were treated with respect and compassion, provided privacy, and had close family members involved in physical care. Identified barriers to dignity included inadequate information about their health condition, poor communication by the nurses, lack of autonomy, poorly designed healthcare infrastructure and inadequate privacy.

CONCLUSIONS

Several enablers and barriers to dignified nursing care have been identified that have been discussed in previous studies. The unique factors identified in the Ghanaian context were family members' involvement in physical care influenced by cultural and religious beliefs, environmental barriers to privacy and dignity and inadequate involvement in decision making.

RELEVANCE TO CLINICAL PRACTICE

Nurses must treat older patients with respect, educate them about the health condition, involve them in care decisions, and identify their preferences regarding provision of hygiene needs, particularly in consideration of religious and cultural beliefs, including involvement of family members. Future planning of healthcare infrastructure needs to consider the importance of private cubicles with disability-accessible ensuite bathrooms for patients' comfort and privacy.

Supporting a review of the benefits package of the National Health Insurance Scheme in Ghana

BACKGROUND

Although Ghana is lauded for its National Health Insurance Scheme (NHIS), concerns exist about the scheme's functioning and sustainability. An often-cited issue-contributing to the scheme's decreasing membership, long-standing financial deficit, and frequent out-of-pocket payments among members-is the large benefits package (BP). While, on paper, the BP covers over 95% of the conditions occurring in Ghana, its design was not informed by any budget analysis, nor any systematic prioritization of interventions. This paper aims to provide evidence-based input into ongoing discussions regarding a review of the NHIS benefits package.

METHODS

An existing analytic framework is used to calculate net health benefit (NHB) for a range of interventions in order to assess their cost-effectiveness and enable the prioritization of 'best buys'. The framework is expanded upon by incorporating concerns for financial protection, and practical feasibility, as well as the political economy challenges of disinvesting in currently funded activities. Five different options for the benefits package, each based on policy discourse in Ghana's health sector, are presented and evaluated.

RESULTS

Implementing all interventions for which data was available to 100% of the population in need was estimated to cost GH₵4323 million (US$994 million), while the available NHIS budget was only GH₵970 million (US$223 million). Options for the benefits package that focussed on cost-effectiveness and primary care provision achieved the best health outcomes, while options reflecting the status quo and allowing for co-payments included a higher number of healthcare interventions. Apart from the package option focussing on primary care, all packages were faced with physician shortages.

CONCLUSIONS

Current funding to the NHIS is insufficient to provide the historical benefits package, which promises to cover over 95% of disease conditions occurring in Ghana, to the total population. Shifting the NHIS focus from intervention coverage to population coverage is likely to lead to better health outcomes. A primary care package may be most feasible in the short-term, though additional physicians should be trained to provide higher-level care that is highly cost-effective, such as emergency neonatal care.

Risky sexual behaviours and HIV testing among young people in Ghana: evidence from the 2017/2018 Multiple Indicator Cluster Survey

Background

Young people have a higher chance of experimenting with sex before marriage, thus they engage in risky sexual behaviours that predispose them to HIV infections. The objective of this study was to assess the relationship between engaging in risky sexual behaviours and the uptake of HIV testing services among young people in Ghana.

Methods

We analysed secondary data from the 2017/2018 Ghana Multiple Indicator Cluster Survey, which collected data on population and health indicators across the previous ten regions of Ghana, using a Computer Personal Assisted Interviewing application. Data were analysed using descriptive statistics, Chi-square test and Binomial Logistic regression.

Results

Seventy-nine per cent (79%) of young women and 68% of young men did not use a condom during last sexual intercourse. In addition, 68% of young women and 87% of young men had not tested for HIV. Young women (AOR = 2.19; 95% CI 1.56–3.07) and young men (AOR = 3.38; 95% CI 1.18–9.64) aged 20–24 years had a higher likelihood of being tested for HIV compared to those aged 15–19 years. Young women with junior high school education (AOR = 2.03; 95% CI 1.08–3.81) were more likely to test for HIV compared with those who had pre-primary/no formal education. In addition, young women who were never married or in a union (AOR = 0.39; 95% CI 0.27–0.56) had 61% of reduced odds of being tested for HIV compared with those who were currently married or in a union. There was no significant association between risky sexual behaviours and HIV testing (p > 0.05).

Conclusion

This study demonstrated that condom use among sexually active young people was low. The uptake of HIV testing services was below expectation. Age, educational status, marital status and exposure to the mass media were the salient factors influencing the uptake of HIV testing among young people. Stakeholders should implement interventions to help increase the uptake of HIV testing and condom use among young people in Ghana.

Sub-Sahara Africa is the only region in the world where the number of young people continues to increase greatly. Many of the new HIV infections among young people across the world happen in sub-Saharan Africa. Young people engage in unsafe sexual behaviours, such as having sex without a condom, beginning sexual intercourse at an early age and having sex with many partners, which increases their chance of getting infected with HIV. Testing for HIV helps in the early discovery of the virus which is crucial for effective HIV management and prevention. Increasing HIV testing is one of the health issues cherished by global health leaders. However, little is known about whether young people who engage in unsafe sexual behaviours utilize HIV testing services. The analysed data were collected as part of the 2017/2018 Multiple Indicator Cluster Survey across all the regions of Ghana. Our findings showed that many of the sexually active young people who participated in the survey had not tested for HIV, hence did not know their HIV status. Making matters worse, many of them engaged in unsafe sexual behaviours, such as unprotected sexual intercourse. Young people aged 20–24 years, those with higher education and married young women were more likely to utilize HIV testing services. To help end HIV as a public health threat by 2030, it is very necessary for stakeholders to educate young people about the dangers associated with unsafe sexual behaviours as well as encourage them to know their HIV status.

The process of developing health workforce strategic plans in Africa: a document analysis

BACKGROUND

Many countries are faced with a multitude of health workforce-related challenges partly attributed to defective health workforce planning. Earlier efforts to guide the process and harmonise approaches to national health workforce policies and planning in the Africa Region included, among others, the development of the WHO Africa Regional Office (WHO/AFRO) Policies and Plans for Human Resources for Health Guidelines for Countries in the WHO African Region in 2006. Although this guideline has led to uniformity and rigour in developing human resources for health (HRH) policies and strategies in Africa, it has become imperative to synthesise the emerging evidence and best practices in the development of health workforce strategies.

METHODS

A document analysis was conducted using the READ ( R eadying materials; E xtracting data; A nalysing data and D istilling) approach.

RESULTS

Fourteen HRH policy/strategic plans were included in the study. The scope of the HRH strategic plans was described in three dimensions: the term of the strategy, sectors covered by the strategy and the health workforce considered in the projections. We found that HRH strategic plan development can be conceptualised as a cyclical, sequential multimethod project, with one phase feeding the subsequent phase with data or instructions. The process is very complex, with different interest groups and sectors that need to be satisfied. The HRH strategic plan development process comprises five main phases linked with external forces and national politics.

CONCLUSION

There is a need for accurate and comprehensive HRH data collection, astute HRH leadership, and broad base and multisectoral stakeholder consultation with technical support and guidance from experts and major external partners for effective HRH strategic plan development.

Planning human resources and facilities to achieve Sustainable Development Goals: a decision-analytical modelling approach to predict cancer control requirements in Indonesia

Objectives

Indonesia aims to achieve universal health coverage (UHC) and Sustainable Development Goals (SDGs), including SDG 3 target 4, which focuses on cancer control, by 2030. This study aimed to forecast the human resources for health (HRH) and facilities required for cancer control in Indonesia over an 11-year period to support these goals.

Design

A two-stage Markov model was developed to forecast the demand side of facilities and HRH requirements for cancer control in Indonesia over an 11-year period.

Setting

Data sources used include the Indonesia Health Profile Report (2019), the Indonesian Radiation Oncology Society Database and National Cancer Control Committee documents (2019).

Methods

The study involved modelling the current availability of HRH and healthcare facilities in Indonesia and predicting future requirements. The gap between the current and the required HRH and facilities related to oncology, and the costs associated with meeting these requirements, were analysed.

Results

Results indicate the need to increase the number of healthcare facilities and HRH to achieve SDG targets. However, UHC for cancer care still may not be achieved, as eastern Indonesia is predicted to have no tertiary hospital until 2030. The forecast shows that Indonesia had a median of only 39% of the HRH requirements in 2019. Closing the HRH gap requires around a 47.6% increase in salary expenditure.

Conclusion

This study demonstrates the application of decision-analytical modelling approach to planning HRH and facilities in the context of a low-to-middle-income country. Scaling up oncology services in Indonesia to attain the SDG targets will require expansion of the number and capability of healthcare facilities and HRH. This work allows an in-depth understanding of the resources needed to achieve UHC and SDGs and could be utilised in other disease areas and contexts.

Nurse managers leadership styles and intention to stay among nurses at the unit in Ghana

INTRODUCTION

Enabling effective leadership is significant in contemporary healthcare delivery. Nurse Managers' (NMs) leadership styles are a major predictor of nurses' retention. Using the 'Full Range Leadership' model as the organising framework, this study explored NMs leadership styles and their influence on intention to stay among nurses in Ghana.

METHODS

A quantitative cross-sectional design using the Multifactor Leadership Questionnaire (MLQ-5x), was used to explore nurses' intention to stay at their current workplace. Data were collected from 348 nurses in 38 selected hospitals and analysed using Pearson correlation and multiple linear regression.

RESULTS

NMs exhibited different leadership styles based on the circumstance, but mostly used a participative leadership style, followed by transformational and transactional leadership styles. Nurses showed a high level of intention to stay. The intention to stay at the current workplace was high (3.26 out of 4) among nurses. The findings show that 85.6% of the nurses had intended to stay. The leadership styles of NMs jointly predicted 20.9% of the variance in intention to stay among nurses.

CONCLUSION

Regular in-service training programs in leadership is critical for NMs to strengthen their leadership skills. NMs should be encouraged to widely use participative leadership styles to foster inclusiveness of staff in the unit.

Physician Experiences and Perceived Barriers to Providing Quality Infertility Care in the Greater Accra Region of Ghana

High-quality, patient-centered care is essential to achieving equity and dignity for individuals with infertility, yet few studies have explored quality of infertility care in sub-Saharan Africa. We interviewed 13 non-specialist physicians and 2 medical school faculty to explore experiences in and perceptions of providing infertility care in Greater Accra, Ghana. We used a patient-centered infertility care model to inform our analysis and results. Individualized care and taking time to counsel and emotionally support patients were perceived as the most important things a physician can do to provide quality infertility care. Financial costs and lack of infertility services within a single facility were the most common barriers reported to providing quality infertility care. To the best of our knowledge, our study is the first to explore quality of infertility care provided by physicians in public sector facilities in Ghana, shedding light on existing barriers and identifying strategies for improvement.

Implications of resource constraints and high workload on speaking up about threats to patient safety: a qualitative study of surgical teams in Ghana

Background

Although under-resourcing of healthcare facilities and high workload is known to undermine patient safety, there is a dearth of evidence about how these factors affect employee voice and silence about unsafe care. We address this gap in the literature by exploring how resource constraints and high workload influence the willingness of staff to speak up about threats to patient safety in surgical departments in Ghana.

Method

Semistructured interviews with a purposeful sample of 91 multidisciplinary professionals drawn from a range of specialities, ranks and surgical teams in two teaching hospitals in Ghana. Conservation of Resources theory was used as a theoretical frame for the study. Data were processed and analysed thematically with the aid of NVivo 12.

Results

Endemic resource constraints and excessive workload generate stress that undermines employee willingness to speak up about unsafe care. The preoccupation with managing scarce resources predisposes managers in surgical units to ignore or downplay concerns raised and not to instigate appropriate remedial actions. Resource constraints lead to rationing and improvising in order to work around problems with inadequate infrastructure and malfunctioning equipment, which in turn creates unsupportive environments for staff to air legitimate concerns. Faced with high workloads, silence was used as a coping strategy by staff to preserve energy and avoid having to take on the burden of additional work.

Conclusion

Under-resourcing and high workload contribute significantly towards undermining employee voice about unsafe care. We highlight the central role that adequate funding and resourcing play in creating safe environments and that supporting ‘hearer’ courage may be as important as supporting speaking up in the first place.

Modelo dinámico para proyectar la necesidad de recursos humanos en salud: anestesistas en Uruguay

Objetivo Desarrollar un modelo dinámico para simular la oferta de médicos especialistas y estimar la brecha especto a la demanda/necesidad en anestesiología en el sistema de salud del Uruguay. Métodos Se desarrolló un modelo de simulación dinámico determinístico implementado en el programa libre R. Se analizaron las proyecciones en el período 2011-2050 y se estimó la brecha a partir de la situación de equilibrio o desequilibrio entre oferta y demanda/necesidad. Se evaluó la calidad del modelo comparando los valores simulados con los datos históricos, con indicadores de bondad de ajuste, como la raíz del error cuadrático medio relativo (rRMSE). Se realizó un análisis de sensibilidad con respecto a los cupos de ingreso a la especia- lidady la tasa de crecimiento de la necesidad de especialistas. Resultados Se proyectó la oferta y demanda de anestesistas para el período considerado. Se obtuvo un rRMSE menor a 0,1, lo que sugiere que el modelo propuesto reproduce adecuadamente la dinámica de la oferta real. Para el período proyectado la situación a mediano y largo plazo es de equilibrio. Conclusión El modelo simulado presenta buen ajuste, por lo que la proyección de la oferta de Recursos Humanos (RR. HH.) representa de forma precisa la disponibilidad futura de la fuerza de trabajo. Además, el modelo representa un insumo de interés para la gestión informada sobre la necesidad de recursos humanos y las políticas de salud, dado que permite evaluar las proyecciones bajo diferentes escenarios.

Modelling the supply and need for health professionals for primary health care in Ghana: Implications for health professions education and employment planning

Background

The health workforce (HWF) is critical in developing responsive health systems to address population health needs and respond to health emergencies, but defective planning have arguably resulted in underinvestment in health professions education and decent employment. Primary Health Care (PHC) has been the anchor of Ghana’s health system. As Ghana’s population increases and the disease burden doubles, it is imperative to estimate the potential supply and need for health professionals; and the level of investment in health professions education and employment that will be necessary to avert any mismatches.

Methods

Using a need-based health workforce planning framework, we triangulated data from multiple sources and systematically applied a previously published Microsoft® Excel-based model to conduct a fifteen-year projection of the HWF supply, needs, gaps and training requirements in the context of primary health care in Ghana.

Results

The projections show that based on the population (size and demographics), disease burden, the package of health services and the professional standards for delivering those services, Ghana needed about 221,593 health professionals across eleven categories in primary health care in 2020. At a rate of change between 3.2% and 10.7% (average: 5.5%) per annum, the aggregate need for health professionals is likely to reach 495,273 by 2035. By comparison, the current (2020) stock is estimated to grow from 148,390 to about 333,770 by 2035 at an average growth rate of 5.6%. The health professional’s stock is projected to meet 67% of the need but with huge supply imbalances. Specifically, the supply of six out of the 11 health professionals (~54.5%) cannot meet even 50% of the needs by 2035, but Midwives could potentially be overproduced by 32% in 2030.

Conclusion

Future health workforce strategy should endeavour to increase the intake of Pharmacy Technicians by more than seven-fold; General Practitioners by 110%; Registered general Nurses by 55% whilst Midwives scaled down by 15%. About US$ 480.39 million investment is required in health professions education to correct the need versus supply mismatches. By 2035, US$ 2.374 billion must be planned for the employment of those that would have to be trained to fill the need-based shortages and for sustaining the employment of those currently available.

Frontline healthcare workers' experiences in implementing the TB-DM collaborative framework in Northern Ghana

Background

Over the past decade, global health policy has increased its focus on measures to halt further increase in tuberculosis (TB) incidence and management of diabetes mellitus (DM). However, the vertical management of these two diseases have not achieved much in addressing the adverse effects of the rising tuberculosis-diabetes co-epidemic. This necessitated the World Health Organisation and the International Union Against Tuberculosis and Lung Disease to develop a framework to manage this dual disease burden.

TB-DM co-epidemic is a public health concern in Ghana, adversely threatening the country’s fragile health systems. Since frontline healthcare workers are critical in health policy implementation, this study used Lipsky’s theoretical framework of street-level bureaucracy to explore their experiences in implementing the collaborative framework at the health facility level in Ghana.

Methods

This qualitative study was conducted between July to September 2019 using an exploratory design. Data was generated using a semi-structured interview guide designed to elicit information on knowledge of TB-DM comorbidity as well as systems for co-management. Twenty-three in-depth interviews were conducted among purposively selected frontline healthcare workers (doctors, nurses, TB task- shifting officers, TB institutional coordinators and hospital managers) from three health facilities in the Northern Region of Ghana. The lead author also conducted observations and document reviews, in order to fully address the study objectives. Thematic analysis was guided by the Lipsky’s theoretical framework of street level bureaucracy.

Results

The findings revealed three main themes and six sub-themes. Main themes were Prioritisation of TB/HIV co-infection while negating TB-DM comorbidity, Poor working conditions, and Coping mechanisms, whereas sub-themes were Low knowledge and awareness of TB-DM comorbidity, Limited awareness of the collaborative framework, High workload in TB & DM Clinics, Multiple roles, Inadequate training, and Space shortage.

Conclusions

Frontline healthcare workers had limited knowledge of TB-DM comorbidity and the collaborative framework, which, in turn adversely affected the effectiveness in implementing the framework. The effective implementation of the framework begins with raising awareness about the framework through in service training amongst the frontline healthcare workers. Additionally, an integrated screening tool to detect both TB and DM would help achieve early detection of TB-DM comorbidity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06883-6.

The cost of health workforce gaps and inequitable distribution in the Ghana Health Service: an analysis towards evidence-based health workforce planning and management

BACKGROUND

Despite tremendous health workforce efforts which have resulted in increases in the density of physicians, nurses and midwives from 1.07 per 1000 population in 2005 to 2.65 per 1000 population in 2017, Ghana continues to face shortages of health workforce alongside inefficient distribution. The Ministry of Health and its agencies in Ghana used the Workload Indicators of Staffing Needs (WISN) approach to develop staffing norms and standards for all health facilities, which is being used as an operational planning tool for equitable health workforce distribution. Using the nationally agreed staffing norms and standards, the aim of this paper is to quantify the inequitable distribution of health workforce and the associated cost implications. It also reports on how the findings are being used to shape health workforce policy, planning and management.

METHODS

We conducted a health workforce gap analysis for all health facilities of the Ghana Health Service in 2018 in which we compared a nationally agreed evidence-based staffing standard with the prevailing staffing situation to identify need-based gaps and inequitable distribution. The cost of the prevailing staffing levels was also compared with the stipulated standard, and the staffing cost related to inequitable distribution was estimated.

RESULTS

It was found that the Ghana Health Service needed 105,440 health workers to meet its minimum staffing requirements as at May 2018 vis-à-vis its prevailing staff at post of 61,756 thereby leaving unfilled vacancies of 47,758 (a vacancy rate of 41%) albeit significant variations across geographical regions, levels of service and occupational groups. Of note, the crude equity index showed that in aggregate, the best-staffed region was 2.17 times better off than the worst-staffed region. The estimated cost (comprising basic salaries, market premium and other allowances paid from central government) of meeting the minimum staffing requirements was estimated to be GH¢2,358,346,472 (US$521,758,069) while the current cost of staff at post was GH¢1,424,331,400 (US$315,117,566.37), resulting in a net budgetary deficit of 57% (~ US$295.4 million) to meet the minimum requirement of staffing for primary and secondary health services. Whilst the prevailing staffing expenditure was generally below the required levels, an average of 28% (range 14-50%) across the levels of primary and secondary healthcare was spent on staff deemed to have been inequitably distributed, thus providing scope for rationalisation. We estimate that the net budgetary deficit of meeting the minimum staffing requirement could be drastically reduced by some 30% just by redistributing the inequitably distributed staff.

POLICY IMPLICATIONS

Efficiency gains could be made by redistributing the 14,142 staff deemed to be inequitably distributed, thereby narrowing the existing staffing gaps by 30% to 33,616, which could, in turn, be filled by leveraging synergistic strategy of task-sharing and/or new recruitments. The results of the analysis provided insights that have shaped and continue to influence important policy decisions in health workforce planning and management in the Ghana Health Service.

Advancing the Population Needs-Based Health Workforce Planning Methodology: A Simulation Tool for Country Application

Although the conceptual underpinnings of needs-based health workforce planning have developed over the last two decades, lingering gaps in empirical models and lack of open access tools have partly constrained its uptake in health workforce planning processes in countries. This paper presents an advanced empirical framework for the need-based approach to health workforce planning with an open-access simulation tool in Microsoft^® Excel to facilitate real-life health workforce planning in countries. Two fundamental mathematical models are used to quantify the supply of, and need for, health professionals, respectively. The supply-side model is based on a stock-and-flow process, and the need-side model extents a previously published analytical frameworks using the population health needs-based approach. We integrate the supply and need analyses by comparing them to establish the gaps in both absolute and relative terms, and then explore their cost implications for health workforce policy and strategy. To illustrate its use, the model was used to simulate a real-life example using midwives and obstetricians/gynaecologists in the context of maternal and new-born care in Ghana. Sensitivity analysis showed that if a constant level of health was assumed (as in previous works), the need for health professionals could have been underestimated in the long-term. Towards universal health coverage, the findings reveal a need to adopt the need-based approach for HWF planning and to adjust HWF supply in line with population health needs.

Burns pain management: The role of nurse-patient communication

BACKGROUND

Nursing is an embodiment of knowledge, clinical work, and interpersonal communication. Effective nursing care has a distinct influence on the overall satisfaction and experience of the patient. Communication is said to be indispensable in the delivery of quality healthcare. Effective communication between nurses and patients has proven to yield better results with pain control and improved psychological status of patients.

OBJECTIVES

The aim of the study is to explore nurses' perceptions on the role of communication in the management of burns pain.

METHODS

A qualitative design with purposive sampling was carried out to recruit 11 registered nurses from a Reconstructive Plastic Surgery and Burns Center in Ghana. To identify the participants' perception on the role of nurse-patient communication in the management of burns pain, a face to face semi-structured interviews were conducted using an interview guide to collect data.

RESULTS

Thematic analysis was done with various themes emerging. Helping patients manage pain, early detection of patient's distress, improved patient participation in their care were some of the positive effects of nurse-patient communication whiles reduced level of cooperation during caregiving, and endurance of pain by the patient were the results of poor nurse-patient communication. Language and time factor were the barriers that were identified to hinder effective communication between nurses and patients.

CONCLUSIONS

Due to the subjective nature of pain, the current study highlights the need for increased communication for an effective assessment and management of pain among patients with burns. It is, therefore, imperative that nurses be well trained in communication with an emphasis on patient-centered communication.

Predictors of Burnout and Depression in Surgeons Practicing in East, Central, and Southern Africa

BACKGROUND

Surgeons are at risk of burnout and depression, which can lead to medical errors, inefficiency, exhaustion, conflicts, and suicide. Significant challenges exist in sub-Saharan Africa that may increase the prevalence of burnout and depression, but no formal evaluation has identified stressors specific to this environment.

METHODS

A survey was distributed to all members of the College of Surgeons of East, Central, and Southern Africa (COSECSA). Burnout, depression, and stressors were assessed with validated measures: Maslach Burnout Inventory for Medical Personnel, Patient Health Questionnaire (PHQ) 9, and Holmes-Rahe Life Stress Inventory.

RESULTS

There were 131 participants (98 African and 33 non-African surgeons). The incidence of moderate to severe depression was 48% (n = 63), and the incidence of burnout was as high as 38% (n = 48). There were no significant differences between African and non-African surgeons in marital status, number of children, partners in practice, or distribution of time. More African surgeons experienced birth of a child (18% versus 3%, P = 0.04) but had less workplace conflict (7.1% versus 10.7%, P = 0.045) than non-African surgeons. African surgeons more consistently felt they were positively influencing others (P = 0.008), enjoyed working with patients (P = 0.009), and were more satisfied (P = 0.04). For all surgeons, predictors of increased PHQ-9 depression were serious professional conflict (P = 0.02), difficulty accessing childcare (P = 0.04), and racial discrimination (P = 0.003). In the Maslach model, predictors of burnout were difficulty accessing childcare (P = 0.05) and denial of promotion based on gender (P = 0.006).

CONCLUSIONS

Burnout and depression in surgeons practicing in East, Central, and Southern Africa are substantial. Despite significant challenges, African surgeons tended to have a more positive outlook on their work. Improvements can be made to reduce burnout and depression by focusing on work conditions, equality of promotion opportunities, workplace conflict management, childcare support, and increasing the numbers of surgeons in practice.

The imperative of evidence-based health workforce planning and implementation: lessons from nurses and midwives unemployment crisis in Ghana

Following periods of health workforce crisis characterised by a severe shortage of nurses, midwives and doctors due to low production rates and excessive out-migration, the Government of Ghana through the Ministry of Health (MOH) responded by expanding training and allowing private sector involvement in the training of health workers especially nurses and midwives. This resulted in substantial increases in the production levels of nurses and midwives even above the projections of the MOH. In this paper, we discuss how a strategy that was seemingly well planned suffered a decade of uncorrected implementation lapses resulting in a lingering need-based shortage of nurses and midwives at service delivery points whilst thousands of trained nurses and midwives remained unemployed for up to 4 years and constantly protesting for jobs. In the short term, we argue that the Government of Ghana would need to increase investment to recruit trained and unemployed nurses and midwives whilst a comprehensive health labour market analysis is conducted to provide robust evidence towards the development of a long-term health workforce plan that would guide future production of nurses and midwives. The Government of Ghana may also explore the option of a managed migration programme to export nurses/midwives to countries that are already destinations to individual migration initiatives in a bid to mitigate the potential skill loss associated with long periods of unemployment after training, especially for those who trained from the private institutions.

Nurses and midwives demographic shift in Ghana-the policy implications of a looming crisis

As part of measures to address severe shortage of nurses and midwives, Ghana embarked on massive scale-up of the production of nurses and midwives which has yielded remarkable improvements in nurse staffing levels. It has, however, also resulted in a dramatic demographic shift in the nursing and midwifery workforce in which 71 to 93% of nurses and midwives by 2018 were 35 years or younger, as compared with 2.8 to 44% in 2008. In this commentary, we examine how the drastic generational transition could adversely impact on the quality of nursing care and how the educational advancement needs of the young generation of the nursing and midwifery workforce are not being met. We propose the institution of a national nursing and midwifery mentorship programme and a review of the study leave policy to make it flexible and be based on a comprehensive training needs assessment of the nursing and midwifery workforce. We further advocate that policymakers should also consider upgrading all professional nursing and midwifery programmes to bachelor degrees as this would not only potentially enhance the quality of training but also address the phenomenon of large numbers of nurses and midwives seeking bachelor degree training soon after employment-sometimes putting them at the offending side of organisational policy.

The implementation process of the Workload Indicators Staffing Need (WISN) method by WHO in determining midwifery staff requirements in Greek Hospitals

INTRODUCTION

One of the greatest challenges in the healthcare field is planning the health workforce under limited financial resources while being fully capable of responding to an affordable, fair and efficient healthcare system. This study aimed to demonstrate the implementation process of the health workforce planning tool ‘Workload Indicators of Staffing Needs’ introduced by the World Health Organization.

METHODS

A descriptive and cross-sectional study was carried out at four (two public and two private) hospitals in Greece, to estimate midwifery staff requirements at ward level during 2015–2016, using the WISN software tool. Focus group discussions, structured interviews and annual service statistics from the hospitals’ records were used to obtain data.

RESULTS

Results for both private hospitals showed a shortage in the number of midwives. However, after combining the interpretation of the results, as indicated by the WISN methodology and the structured interviews, current and required staffing is in balance in both. On the other hand, both public hospitals indicate a surplus of midwives (1.83 and 1.33 ratios for the General hospitals in Korinthos and Kalamata, respectively).

CONCLUSIONS

This study demonstrated the implementation process of the WISN methodology through its application in midwifery staff at four hospitals in Greece and confirmed its usefulness in estimating staffing requirements. The application of the WISN methodology should be viewed as a vital tool in assessing overstaffing and understaffing through the estimation of workload pressure among different categories of health staff, thus providing the basis for effective health workforce redistribution in Greece.