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Li H, Yuan B, Song S, Meng Q, Kawachi I. Trends in resource allocation for primary health care in rural China: Concentration curve and decomposition analysis. Int J Health Plann Manage 2024. [PMID: 39054616 DOI: 10.1002/hpm.3828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/03/2022] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
Since 2009, China has made large investments in strengthening the primary healthcare system. This study aimed to examine the trends in the number and distribution of health resources in rural China following the health system reform and to decompose the sources of inequalities. Data were collected from standardized reports compiled by each county in rural China and compiled by the National Health Commission and Bureau of Statistics. From the findings of this empirical study, resource allocation per capita for primary health care (PHC) improved gradually from 2008 to 2014. The distribution of beds across counties (ranked by level of economic development) was relatively equitable. However, the concentration curve analysis indicated that the distribution of primary care professionals remained skewed in favour of wealthier and more urbanised counties. Economic status was proved to be a major contributor to the inequality of health human resource. China's primary care reforms resulted in simultaneously improved supply of PHC resources as well as pro-rich inequality in distribution of the workforce. To advance equality in health resource allocation, greater attention should be paid to the substantial inequality of economic status within counties.
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Affiliation(s)
- Huiwen Li
- China Population and Development Research Center, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Suhang Song
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Wang Z, Lin T, Xing X, Cai B, Chen Y. Dynamic distribution, regional differences and convergence of health workforce allocation in township health centers in China. Heliyon 2024; 10:e23857. [PMID: 38192759 PMCID: PMC10772724 DOI: 10.1016/j.heliyon.2023.e23857] [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: 05/25/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
This study evaluated the dynamic distribution, regional differences, and convergence of health workforce allocation in Township Health Centers in China during 2011-2020 using data obtained from the China Health Statistics Yearbook (2012-2021). The Gini coefficient and kernel density estimation were chosen to examine the dynamic distribution and regional differences in health workforce allocation in Township Health Centers in China and their components. σ convergence and β convergence were used to investigate the change trend of health workforce allocation in Township Health Centers. The results show that between 2011 and 2020, the number of licensed doctors and registered nurses per thousand population in Township Health Centers both increased largely and regional disparities still exist. In 2020, the largest differences in the density of licensed doctors and registered nurses were found in the eastern and central regions, respectively, and the intensity of trans-variation contributed the most to the overall disparities. The allocation of licensed doctors and registered nurses both exhibited σ convergence, absolute and conditional β convergence, indicating that the regional differences in health workforce in THCs among provinces will decrease. The growth of healthcare workforce was positively impacted by the urbanization rate, growth rate of government health expenditures and growth domestic product per capita, but negatively impacted by population density in rural areas and fiscal self-sufficiency.
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Affiliation(s)
- Zuobao Wang
- School of Humanities and Law, Northeastern University, Shenyang, 110169, China
| | - Tianrun Lin
- School of Humanities and Law, Northeastern University, Shenyang, 110169, China
| | - Xinyi Xing
- School of Humanities and Law, Northeastern University, Shenyang, 110169, China
| | - Bingshu Cai
- School of Humanities and Law, Northeastern University, Shenyang, 110169, China
| | - Yao Chen
- School of Management, Shenyang Urban Construction University, Shenyang, 110167, China
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Ma Y, Xiao P, Yu L, Ni H, Huang S, Wang M, Huang Y, Li L, Yang L, Tan C, Zhong Z. The allocation and fairness of health human resources in Chinese maternal and child health care institutions: a nationwide longitudinal study. BMC Health Serv Res 2023; 23:151. [PMID: 36782193 PMCID: PMC9926631 DOI: 10.1186/s12913-023-09076-5] [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: 07/16/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND In response to an aging population, the Chinese government implemented the three-child policy in 2021 based on the comprehensive two-child policy. With the implementation of the new birth policy, people's maternal and child health (MCH) needs will also increase. The allocation and fairness of MCH human resources directly affect people's access to MCH services. The purpose of this study is to analyze the allocation of health human resources in Chinese maternal and child health care institutions, evaluate the fairness of the allocation, to provide a reference for the rational allocation of MCH human resources. METHODS The data of health technicians, licensed (assistant) physicians, and registered nurses in maternal and child health care institutions nationwide from 2016 to 2020 were included. The health resource density index (HRDI) is used to evaluate the allocation level of MCH human resources. The Gini coefficient (G) and Theil index (T) are used to evaluate the fairness of the allocation of MCH human resources from the perspectives of population and geographic area. RESULTS From 2016 to 2020, the average annual growth rate of the number of health technicians, licensed (assistant) physicians, and registered nurses in Chinese maternal and child health care institutions was 7.53, 6.88, and 9.12%, respectively. The Gini coefficient (G) of the three types of MCH human resources allocated by population were all below 0.23, and the Gini coefficient (G) allocated by geographical area were all above 0.65. The Theil index (T) of the three types of MCH human resources allocated by population was all lower than 0.06, and the Theil index (T) allocated by geographical area was all higher than 0.53. In addition, the three types of MCH human resources allocated by population and geographic area contributed more than 84% of the Theil index within the group (Tintra) to the Theil index (T). CONCLUSIONS China's MCH human resources were fair in terms of population allocation, but unfair in terms of geographical area allocation. In the future, more attention should be paid to the geographical accessibility of MCH human resources, and the allocation of resources should comprehensively consider the two factors of serving the population and geographical area.
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Affiliation(s)
- Yuan Ma
- grid.461863.e0000 0004 1757 9397Department of Medical Record Management, West China Second University Hospital, Chengdu, Sichuan, China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan China
| | - Pei Xiao
- grid.13291.380000 0001 0807 1581Medical Insurance Office, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan China
| | - Li Yu
- grid.461863.e0000 0004 1757 9397Department of Medical Record Management, West China Second University Hospital, Chengdu, Sichuan, China
| | - Henfan Ni
- grid.412901.f0000 0004 1770 1022Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Shiyao Huang
- grid.412901.f0000 0004 1770 1022Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan China ,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan China
| | - Meixian Wang
- grid.461863.e0000 0004 1757 9397National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yuxiang Huang
- grid.461863.e0000 0004 1757 9397Department of Medical Record Management, West China Second University Hospital, Chengdu, Sichuan, China
| | - Li Li
- grid.461863.e0000 0004 1757 9397Department of Medical Record Management, West China Second University Hospital, Chengdu, Sichuan, China
| | - Lian Yang
- grid.411304.30000 0001 0376 205XSchool of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan China
| | - Chunjian Tan
- grid.460068.c0000 0004 1757 9645Department of Quality Control and Evaluation, Chengdu Third People’s Hospital, Chengdu, Sichuan China
| | - Zhigang Zhong
- Department of Prevention, Office of Cancer Prevention and Treatment, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital Affiliate to University of Electronic Science and Technology of China, 610041, Chengdu, Sichuan, China.
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Noree T, Pagaiya N, Nimnual I. Effect of doctor allocation policies on the equitable distribution of doctors in Thailand. HUMAN RESOURCES FOR HEALTH 2023; 21:1. [PMID: 36639659 PMCID: PMC9838019 DOI: 10.1186/s12960-022-00782-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Equitable geographic distribution of doctors is crucial for the provision of an accessible and efficient health service system. This study aimed to assess the effects of doctor allocation by the Thai Ministry of Public Health (MoPH) in relation to equity distribution. METHODS This descriptive study compared secondary data on the number of doctors, gross provincial products (GPP), and populations of 76 Thai provinces for the years 2017 and 2021. The ratio of doctors to 1000 population was used to measure the spatial distribution of doctors by province. Lorenz curves and the Gini coefficient were used to determine the equity of doctor distribution. RESULTS The results showed that the Gini coefficient decreased from 0.191 in 2017 to 0.03 in 2021 indicating that the equitable distribution of doctors improved after the MoPH commenced allocating newly graduated doctors according to health utilization in 2017. Compared to 2017, the percentage changes in the number of doctors were higher in provinces with lower doctor densities and in provinces with higher GPPs. CONCLUSION The equitable distribution of doctors in Thailand was affected by two main causes: the allocation of newly graduated doctors by the MoPH and the turnover rate of existing doctors.
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Affiliation(s)
- Thinakorn Noree
- International Health Policy Program, Ministry of Public Health, Tiwanon Road, Muang, 11000 Nothaburi Thailand
| | - Nonglak Pagaiya
- Faculty of Public Health, Khonkaen University, 123 Mitraphap Road, Muang, Khonkaen, 40000 Thailand
| | - Intira Nimnual
- International Health Policy Program, Ministry of Public Health, Tiwanon Road, Muang, 11000 Nothaburi Thailand
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Kumluang S, Geue C, Langhorne P, Wu O. Availability of stroke services and hospital facilities at different hospital levels in Thailand: a cross-sectional survey study. BMC Health Serv Res 2022; 22:1558. [PMID: 36539806 PMCID: PMC9764597 DOI: 10.1186/s12913-022-08922-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Stroke has one of the biggest burden of disease in Thailand and all health regions have been tasked to develop their service delivery to achieve the national key performance indicators set out by the Thai service plan strategy 2018-2022. Our aim was to characterise stroke services and hospital facilities by investigating differences in facilities across different hospital levels in Thailand. METHODS Self-complete questionnaires were distributed to 119 hospitals in 12 health regions between November-December 2019. Participants were health professionals whose main responsibilities are related to stroke service provision in their hospital. Descriptive statistics were used to report differences of stroke service provision between advanced-level, standard-level and mid-level referral hospitals. RESULTS Thirty-eight (32% response rate) completed questionnaires were returned. All advanced-level, standard-level (100%) and 55% of mid-level referral hospitals provided stroke units. Neurologists were available in advanced-level (100%) and standard-level referral hospitals (50%). Standard-level and mid-level referral hospitals only had a quarter of rehabilitation physicians compared to advanced-level referral hospital. Home-based rehabilitation was provided at 100% in mid-level but only at 16% and 50% in advanced-level and standard-level referral hospitals. CONCLUSIONS Setting up a stroke unit, as a national goal that was set out in the service plan strategy 2018-2022, was achieved fully (100%) in advanced-level and standard-level referral hospitals including key essential supportive components. However, capacity in hospitals was found to be limited and stroke service delivery needs to be improved especially at mid-level referral hospitals. This should include regular organisational surveys and the use of electronic records to facilitate monitoring of clinical/health outcomes of patients.
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Affiliation(s)
- Suthasinee Kumluang
- grid.8756.c0000 0001 2193 314XHealth Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Claudia Geue
- grid.8756.c0000 0001 2193 314XHealth Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Langhorne
- grid.8756.c0000 0001 2193 314XSchool of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Olivia Wu
- grid.8756.c0000 0001 2193 314XHealth Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Pratt G, Johnston C. Dementia Care for Europeans in Thailand: A Geography of Futures. THE AMERICAN BEHAVIORAL SCIENTIST 2022; 66:1880-1895. [PMID: 36366768 PMCID: PMC9638707 DOI: 10.1177/00027642221075263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We explore the creation of private care facilities around Chiang Mai in northern Thailand to provide dementia care for people from the Global North. We draw on three periods of ethnographic observation at care facilities, and interviews with Swiss and British owners and family members, as well as Thai managers and care workers. We locate this offshoring of dementia care from the Global North to South within existing underfunding of dementia care in the Global North and a "regime of anticipation" built around expected substantial growth in the numbers of people living with dementia. These facilities are opening new futures for those who migrate for care as they leverage their relative wealth and privilege to purchase care in Thailand. In line with other readings of international health migration, we note the negative impact of this state-supported privatized industry on the availability of nurses and care aids in public hospitals in Thailand. We then venture into less examined and expected futurities, namely, the opportunities these facilities provide to two groups of stigmatized Thai workers: transgender and Indigenous Karen caregivers.
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Affiliation(s)
- Geraldine Pratt
- Department of Geography, University of British Columbia, Vancouver, BC, Canada
| | - Caleb Johnston
- School of Geography, Politics and Sociology, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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Kitiyakara T, Leerapun A, Sutthivanan C, Poovorawan K, Pan-Ngum W, Soonthornworasiri N, Chaiteerakij R, Treeprasertsuk S, Phaoswasdi K, Mairiang P, Kositchaiwat C. Regional Differences in Admissions and Treatment Outcomes for Hepatocellular Carcinoma Patients in Thailand. Asian Pac J Cancer Prev 2022; 23:3701-3715. [PMID: 36444583 PMCID: PMC9930940 DOI: 10.31557/apjcp.2022.23.11.3701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the commonest cancers in Thailand. We report the stage and survival of patients who were admitted under the public universal health fund (NHSO) covering 47 million people to determine if there were regional disparities in the treatment outcomes in the country. METHOD We used the 2009-2013 Nationwide Hospital Admission Data, Thailand. Patients with hepatocellular carcinoma (HCC) were identified by the ICD10 code C22.0. Procedures were identified by ICD9-CM codes, and deaths were confirmed from the NHSO database and the national citizen registry. Thailand is divided into 6 regions and Bangkok. Hospitals were identified according to their specific reimbursement codes. Survival time started from the day of first admission and was estimated using the Kaplan-Meier method. The statistical method used to compare regions was Chi-squared tests (Pearson, likelihood ratio, linear-by linear association and Mantel-cox). RESULTS There were 36,956 HCC patients admitted during the study period. The overall median survival was 36 days. 1.63% of the patients had surgery, 0.96% had radiofrequency ablation (RFA), and 5.24% had trans-arterial chemoembolization (TACE). 90.24% did not have any tumor-specific therapy. The proportion of patients admitted for tumor-specific therapy vs. no tumor-specific therapy was significantly different between regions in all treatment modalities (p<0.01). Each treatment modality showed a wide range of median survival values across the regions (p<0.01). The best survival was seen in Bangkok, the South and the North (for surgery, RFA and TACE) and was often more than twice as long as the regions with the lowest survival, Central, East and West. CONCLUSIONS There was a large previously-unreported disparity in admissions and outcomes in Thailand for different treatment modalities for HCC. Bangkok and the South had the best treatment outcomes and often had median survivals more than twice as long as those in the West and East. Public policy to reduce this disparity will need to be implemented in the future.
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Affiliation(s)
- Taya Kitiyakara
- Division of Gastroenterology and Hepatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. ,For Correspondence:
| | - Apinya Leerapun
- Department of Medicine, Faculty of Medicine, Chiangmai University, Bangkok, Thailand.
| | | | - Kittiyod Poovorawan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Wirichada Pan-Ngum
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | | | - Roongruedee Chaiteerakij
- Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, and Thai Red Cross Society, Pathumwan, Bangkok, Thailand.
| | - Sombat Treeprasertsuk
- Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, and Thai Red Cross Society, Pathumwan, Bangkok, Thailand.
| | | | | | - Chomsri Kositchaiwat
- Division of Gastroenterology and Hepatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Teerasarntipan T, Sritunyarat Y, Prathyajuta P, Pitakkitnukun P, Phathong C, Ariyaskul D, Kulkraisri K, Tangkijvanich P, Treeprasertsuk S, Rerknimitr R, Chaiteerakij R. Physician- and patient-reported barriers to hepatocellular carcinoma surveillance: A nationwide survey. Medicine (Baltimore) 2022; 101:e30538. [PMID: 36086710 PMCID: PMC10980473 DOI: 10.1097/md.0000000000030538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Hepatocellular carcinoma (HCC) surveillance rates are suboptimal. We aimed to identify HCC surveillance barriers from both physician's and patient's perspectives and assess the effectiveness of physician education using social networks. A nationwide survey with 513 physicians and another single-center survey with 315 HCC-risk patients were conducted. Barriers to suboptimal surveillance were identified using univariate and multivariate logistic regression analysis. We educated 143 physicians by sending brief notes on HCC surveillance guidelines via social networks and re-evaluated their knowledge after 60 days using t test. Surveys showed 458 (86.3%), 254 (47.8%), and 225 (42.4%) physicians recommended surveillance in patients with cirrhosis, at-risk hepatitis B virus, and hepatitis C virus infection, respectively. Only 228 (42.9%) and 241 (38.0%) respondents adhered to recommended surveillance tools and interval, respectively. The main surveillance barriers among physicians were the lack of knowledge and resource limitations. The lack of a doctor's prescription was identified as a major barrier by patient' perspectives (odds ratio 1.4, 95% CI: 1.1-1.8, P = .024). Education via social networks enhanced physicians' knowledge, with pre- and post-education scores for guideline awareness of 63.0% versus 84.3% (P < .001) and for surveillance indication and tools of 40.0% versus 63.0% (P = .001), and 42.0% versus 59.3% (P = .015), respectively. Physicians' knowledge gap is a primary barrier for adherence to HCC surveillance protocols. Brief education via social networks shows effectiveness at increasing physicians' knowledge of HCC surveillance.
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Affiliation(s)
- Tongluk Teerasarntipan
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yingluk Sritunyarat
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | | | - Chonlada Phathong
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | | | - Pisit Tangkijvanich
- Liver Research Unit and Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Roongruedee Chaiteerakij
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Potempa K, Rajataramya B, Singha-Dong N, Furspan P, Kahle E, Stephenson R. Thailand's Challenges of Achieving Health Equity in the Era of Non-Communicable Disease. PACIFIC RIM INTERNATIONAL JOURNAL OF NURSING RESEARCH 2022; 26:187-197. [PMID: 35432661 PMCID: PMC9012244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Thailand is an exemplar of the challenges faced in addressing the increasing dual demands of aging populations and increasing incidence of non-communicable disease (NCDs). By understanding the dilemmas and solutions posed by Thailand, we propose a framework of key factors to be addressed in order to accelerate capacity in addressing the NCDs challenges in aging populations. Methods proposed by world health organizations to improve population health could impact NCDs if Quality Adjusted Life Years (QALYs) are increased as well as life expectancy through these measures. Four recommendations for achieving these objectives are discussed: expand investments in health care infrastructure for NCDs prevention and early detection; expand public health policies to full population health goals; expand to universal coverage for health care access; engage multi-sectoral constituencies in policy and strategic implementation programs for health. With the emergence of an aging population and the inevitable rise in NCDs, the Thai government is engaging each element of our recommendations and grappling with the policy trade-offs in the context of broader economic and other strategic goals. The experience of Thailand in achieving its goal of population health is a case study of focus, perseverance, and consistent policy strategies.
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Affiliation(s)
| | | | - Naruemol Singha-Dong
- Suranaree University of Technology Institute of Nursing Nakhon Ratchasima, Thailand
| | | | - Erin Kahle
- University of Michigan School of Nursing and Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Rob Stephenson
- University of Michigan School of Nursing and Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
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Theucksuban B, Kunaviktikul W, Wichaikhum OA, Abhicharttibutra K. Testing a model of Thai nurses' intent to stay in employment. Int Nurs Rev 2022; 69:450-458. [PMID: 35305265 DOI: 10.1111/inr.12753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 02/11/2022] [Indexed: 11/27/2022]
Abstract
AIM To test the causal model of intent to stay in employment of nurses in regional medical centers. BACKGROUND Effectiveness and quality of nursing care are determined by an adequate number of nursing staff; however, there is an ongoing challenge of nursing shortage. Improving nurses' intention to remain in employment is an effective way to address the problem of nursing shortage. METHODS This study employed a cross-sectional design. The sample was 1224 registered nurses from nine regional medical centers across Thailand, selected using multistage random sampling. Data were collected between January and July 2019 and analyzed with structural equation modeling. RESULTS AND DISCUSSION The final model could explain 40.3% of the variance in intent to stay. Transformational leadership, coworker support, professional autonomy, opportunities for promotion, marital status, and job satisfaction positively affected intent to stay, while burnout negatively affected intent to stay. This indicates that seven factors that should be considered by nurse managers in developing a framework for constructing interventions to increase nurses' intention to continue working in their organization. IMPLICATION FOR NURSING AND NURSING POLICY Nurse managers should strengthen the intent to stay of nurses by providing consultations, building a positive work atmosphere, and encouraging nurse leaders to apply transformational leadership behaviors to the organizational administration. Policymakers should consider enacting policies and regulations for nurses' benefits, such as allocating civil servant positions to temporary nursing staff, expanding the framework of career advancement to a senior professional position, and considering salary and overtime pay, to increase nurses' intent to stay in an organization.
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Chen J, Lin Z, Li LA, Li J, Wang Y, Pan Y, Yang J, Xu C, Zeng X, Xie X, Xiao L. Ten years of China's new healthcare reform: a longitudinal study on changes in health resources. BMC Public Health 2021; 21:2272. [PMID: 34903184 PMCID: PMC8670033 DOI: 10.1186/s12889-021-12248-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China launched a new round of healthcare-system reform in 2009 and proposed the goal of equal and guaranteed essential medical and health services for all by 2020. We aimed to investigate the changes in China's health resources over the past ten years after the healthcare reform. METHODS Data were collected from the China Statistical Yearbook and China Health Statistics Yearbook from 2009 to 2018. Four categories and ten indicators of health resources were analyzed. A descriptive analysis was used to present the overall condition. The Health Resource Density Index was applied to showcase health-resource distribution in demographic and geographic dimensions. The global and local Moran's I were used to assess the spatial autocorrelation of health resources. Concentration Index (CI) was used to quantify the equity of health-resource distribution. A Geo-Detector model and Geographic Weighted Regression (GWR) were applied to assess the association between gross domestic product (GDP) per capita and health resources. RESULTS Health resources have increased over the past ten years. The global and local Moran's I suggested spatial aggregation in the distribution of health resources. Hospital beds were concentrated in wealthier areas, but this inequity decreased yearly (from CI=0.0587 in 2009 to CI=0.0021 in 2018). Primary medical and health institutions (PMHI) and their beds were concentrated in poorer areas (CI remained negative). Healthcare employees were concentrated in wealthier areas (CI remained positive). In 2017, the q-statistics indicated that the explanatory power of GDP per capita to beds, health personnel, and health expenditure was 40.7%, 50.3%, and 42.5%, respectively. The coefficients of GWR remained positive with statistical significance, indicating the positive association between GDP per capita and health resources. CONCLUSIONS From 2009 to 2018, the total amount of health resources in China has increased substantially. Spatial aggregation existed in the health-resources distribution. Health resources tended to be concentrated in wealthier areas. When allocating health resources, the governments should take economic factors into account.
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Affiliation(s)
- Jiang Chen
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuochen Lin
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li-An Li
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Li
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuyao Wang
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Pan
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Yang
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuncong Xu
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaojing Zeng
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxu Xie
- School of Public Health, Fujian Medical University, Fuzhou, China.
| | - Liangcheng Xiao
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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12
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Sotodeh Manesh S, Hedayati Zafarghandi M, Merati Z, Ebrahimzadeh J, Delpasand M. Inequality trends in the distribution of healthcare human resources in eastern Iran. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211041177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Inequitable distribution of human resources in healthcare is one of the main obstacles to improve any health system. This study aimed to evaluate inequalities in the distribution of human resources in healthcare in South Khorasan Province, Iran. Methods We have investigated three types of health staff (i.e. nurses, general practitioners, and specialists) from 2013 to 2018. Data were collected from the annual reports of the Statistical Centre of Iran. The Gini coefficient and time trend regression were applied to measure the inequality. Results The distribution of specialists and general practitioners were the highest and lowest inequality, respectively. Inequalities in the distribution of nurses and specialists have decreased from 2013 to 2018, while the Gini coefficients of the general practitioners have increased from 0.31 to 0.38. According to the regression analysis, inequality in the distribution of nurses and specialists was decreasing over the time; however, the decline was only significant for specialists. While the coefficient B for general practitioners is positive, this indicates raised inequality, but the observed increase was not significant. Conclusions This study revealed that Iran, similar to several other low- and middle-income countries, is with faced the challenge of inequitable distribution of human resources in healthcare, which in turn indicates the necessity of reforms at national and regional levels to address inequalities in the distribution of healthcare human resources, particularly in South Khorasan Province. Hence, the main policy recommendation is to focus on continuous monitoring and evaluation of resource allocation in South Khorasan Province to reduce inequalities.
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Affiliation(s)
- Sam Sotodeh Manesh
- Department of Health Services Management, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Hedayati Zafarghandi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Merati
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javad Ebrahimzadeh
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoor Delpasand
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Vanichkulbodee A, Inboriboon PC, Balk AH, Sri-on J. Perception of an Introductory Point-of-Care Ultrasound Course for Thai Medical Students on Emergency Medicine Rotation. Open Access Emerg Med 2021; 13:291-298. [PMID: 34267560 PMCID: PMC8275160 DOI: 10.2147/oaem.s316730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Point-of-care ultrasonography (POCUS) is increasingly utilized in emergency departments (EDs) throughout Thailand. Although emergency medicine (EM) residents are trained in POCUS, Thai medical students receive limited training. An introductory POCUS course was implemented for medical students to prepare them for internships. OBJECTIVE This study described the perception and use of POCUS by graduates of an introductory POCUS course. MATERIALS AND METHODS Medical students who completed the POCUS course were surveyed during their intern year from 2012 to 2015. The survey collected demographic characteristics. The Likert Scale was used to assess POCUS practice patterns and perceptions of the course. RESULTS There were 230 respondents (98% response rate). All thought that POCUS was important. Furthermore, 96% of respondents felt that the POCUS course meaningfully impacted their ability to deliver care. POCUS use was greatest for obstetrics/gynecology and trauma cases. Over half of respondents (55.2%) felt very confident with using extended-Focused Assessment with Sonography in Trauma. Most respondents (81.8%) were positively impacted by the course, and 61.7% were satisfied with the scope of the course. Recommendations for improvement included increasing the course length, the content, and the hands-on time for POCUS practice. CONCLUSION Graduates positively perceived the course and felt it dramatically impacted their clinical practice as novice physicians. An introductory POCUS course should be incorporated into the medical school curriculum to prepare graduates for practice. Future goals include increasing the scope of POCUS practice to help guide interns and residents in emergency patient care such as lung ultrasound in COVID-19 or pneumonia patients and studying the impact this course has on patient outcomes.
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Affiliation(s)
- Alissara Vanichkulbodee
- Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA
| | | | - Andrew H Balk
- Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA
| | - Jiraporn Sri-on
- Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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14
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Laowahutanon T, Nakamura H, Tachimori H, Nomura S, Liabsuetrakul T, Lim A, Rawdaree P, Suchonwanich N, Yamamoto H, Ishizuka A, Shibuya K, Miyata H, Chongsuvivatwong V. Hospital admission for type 2 diabetes mellitus under the Universal Coverage Scheme in Thailand: A time- and geographical-trend analysis, 2009-2016. PLoS One 2021; 16:e0253434. [PMID: 34197492 PMCID: PMC8248737 DOI: 10.1371/journal.pone.0253434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 06/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Descriptive analyses of 2009-2016 were performed using the data of the Universal Coverage Scheme (UCS) which covers nearly 70 percent of the Thai population. The analyses described the time and geographical trends of nationwide admission rates of type 2 diabetes mellitus (T2DM) and its complications, including chronic kidney disease (CKD), myocardial infarction, cerebrovascular diseases, retinopathy, cataract, and diabetic foot amputation. METHODS AND FINDINGS The database of T2DM patients aged 15-100 years who were admitted between 2009 and 2016 under the UCS and that of the UCS population were retrieved for the analyses. The admitted cases of T2DM were extracted from the database using disease codes of principal and secondary diagnoses defined by the International Classification of Diseases 9th and 10th Revisions. The T2DM admission rates in 2009-2016 were the number of admissions divided by the number of the UCS population. The standardized admission rates (SARs)were further estimated in contrast to the expected number of admissions considering age and sex composition of the UCS population in each region. A linearly increased trend was found in T2DM admission rates from 2009 to 2016. Female admission rates were persistently higher than that of males. In 2016, an increase in the T2DM admission rates was observed among the older ages relative to that in 2009. Although the SARs of T2DM were generally higher in Bangkok and central regions in 2009, except that with CKD and foot amputation which had higher trends in northeastern regions, the geographical inequalities were fairly reduced by 2016. CONCLUSION Admission rates of T2DM and its major complications increased in Thailand from 2009 to 2016. Although the overall geographical inequalities in the SARs of T2DM were reduced in the country, further efforts are required to improve the health system and policies focusing on risk factors and regions to manage the increasing T2DM.
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Affiliation(s)
| | - Haruyo Nakamura
- International Development Center of Japan Inc., Tokyo, Japan
| | - Hisateru Tachimori
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation National Center for Global Health and Medicine, Shinjuku City, Japan
- Endowed Course for Health System Innovation, Keio University School of Medicine, Minato City, Japan
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, Keio University School of Medicine, Minato City, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Apiradee Lim
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University Pattani Campus, Pattani, Thailand
| | - Petch Rawdaree
- Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Netnapis Suchonwanich
- The Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
| | - Hiroyuki Yamamoto
- Department of Health Policy and Management, Keio University School of Medicine, Minato City, Japan
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Japan
| | - Aya Ishizuka
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation National Center for Global Health and Medicine, Shinjuku City, Japan
- Department of Health Policy and Management, Keio University School of Medicine, Minato City, Japan
| | - Kenji Shibuya
- Soma COVID Vaccination Medical Center, Fukushima, Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management, Keio University School of Medicine, Minato City, Japan
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Issac A, Radhakrishnan RV, Vijay VR, Stephen S, Krishnan N, Jacob J, Jose S, Azhar SM, Nair AS. An examination of Thailand's health care system and strategies during the management of the COVID-19 pandemic. J Glob Health 2021; 11:03002. [PMID: 33643614 PMCID: PMC7897427 DOI: 10.7189/jogh.11.03002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Alwin Issac
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | | | - V R Vijay
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Shine Stephen
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Nadiya Krishnan
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Jaison Jacob
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Sam Jose
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - S M Azhar
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Anoop S Nair
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
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Xu J, Zheng J, Xu L, Wu H. Equity of Health Services Utilisation and Expenditure among Urban and Rural Residents under Universal Health Coverage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E593. [PMID: 33445637 PMCID: PMC7826610 DOI: 10.3390/ijerph18020593] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/01/2023]
Abstract
Worldwide countries are recognising the need for and significance of universal health coverage (UHC); however, health inequality continues to persist. This study evaluates the status and equity of residents' demand for and utilisation of health services and expenditure by considering the three components of universal health coverage, urban-rural differences, and different income groups. Sample data from China's Fifth Health Service Survey were analysed and the 'five levels of income classification' were used to classify people into income groups. This study used descriptive analysis and concentration index and concentration curve for equity evaluation. Statistically significant differences were found in the demand and utilisation of health services between urban and rural residents. Rural residents' demand and utilisation of health services decreased with an increase in income and their health expenditure was higher than that of urban residents. Compared with middle- and high-income rural residents, middle- and lower-income rural residents faced higher hospitalisation expenses; and, compared with urban residents, equity in rural residents' demand and utilisation of health services, and annual health and hospitalisation expenditures, were poorer. Thus, equity of health service utilisation and expenditure for urban and rural residents with different incomes remain problematic, requiring improved access and health policies.
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Affiliation(s)
- Jianqiang Xu
- School of Management, Xuzhou Medical University, Xuzhou 221004, China;
| | - Juan Zheng
- School of Management, Xuzhou Medical University, Xuzhou 221004, China;
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan 250012, China;
| | - Hongtao Wu
- School of Management, Tsinghua University, Beijing 100084, China;
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Nankongnab N, Kongtip P, Tipayamongkholgul M, Silpasuwan P, Kaewboonchoo O, Luksamijarulkul P, Woskie S. Occupational hazards, health conditions and personal protective equipment used among healthcare workers in hospitals, Thailand. HUMAN AND ECOLOGICAL RISK ASSESSMENT : HERA 2020; 27:804-824. [PMID: 34539172 PMCID: PMC8448198 DOI: 10.1080/10807039.2020.1768824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 06/13/2023]
Abstract
This cross-sectional study aimed to evaluate occupational hazards, health conditions and personal protective equipment used among healthcare workers. Information from the sample size of 1,128 healthcare workers were collected using questionnaires. The healthcare workers participated in this study were from five departments including inpatient, outpatient, surgery and anesthesia, nutrition service and hospital support services departments in five hospitals in Thailand. The results indicated that the majority of healthcare workers were female; these healthcare workers work 9.0 to 11.1 hours/day on average and were exposed to several chemical, biological and physical hazards. The healthcare workers in the nutrition service department reported the highest percentage of musculoskeletal disorder and respiratory problems. The highest percentage of skin problems were reported by healthcare workers in surgery and anesthesia department. The results showed musculoskeletal disorder, respiratory and skin problem significantly differed among healthcare workers in the five departments including the wrists/hands (p = 0.024), upper back (p = 0.009), chest pain symptoms (p = 0.004), and dry/wound symptoms (p = 0.013). Healthcare workers did not have adequate protection from work-related hazards in their workplace. Health education programs, control measures and organizational policies should be implemented to mitigate the hazards for healthcare workers in hospitals.
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Affiliation(s)
- Noppanun Nankongnab
- Faculty of Public Health, Department of Occupational Health and Safety, Mahidol University, Center of Excellence on Environmental Health and Toxicology, Commission on Higher Education, Ministry of Education, Bangkok, Thailand
| | - Pornpimol Kongtip
- Faculty of Public Health, Department of Occupational Health and Safety, Mahidol University, Center of Excellence on Environmental Health and Toxicology, Commission on Higher Education, Ministry of Education, Bangkok, Thailand
| | | | - Pimpan Silpasuwan
- Thai Public Health Nurses Association, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Orawan Kaewboonchoo
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | | | - Susan Woskie
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA
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Rocha TAH, Vissoci J, Rocha N, Poenaru D, Shrime M, Smith ER, Rice HE. Towards defining the surgical workforce for children: a geospatial analysis in Brazil. BMJ Open 2020; 10:e034253. [PMID: 32209626 PMCID: PMC7202732 DOI: 10.1136/bmjopen-2019-034253] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The optimal size of the health workforce for children's surgical care around the world remains poorly defined. The goal of this study was to characterise the surgical workforce for children across Brazil, and to identify associations between the surgical workforce and measures of childhood health. DESIGN This study is an ecological, cross-sectional analysis using data from the Brazil public health system (Sistema Único de Saúde). SETTINGS AND PARTICIPANTS We collected data on the surgical workforce (paediatric surgeons, general surgeons, anaesthesiologists and nursing staff), perioperative mortality rate (POMR) and under-5 mortality rate (U5MR) across Brazil for 2015. PRIMARY AND SECONDARY OUTCOME MEASURES We performed descriptive analyses, and identified associations between the workforce and U5MR using geospatial analysis (Getis-Ord-Gi analysis, spatial cluster analysis and linear regression models). FINDINGS There were 39 926 general surgeons, 856 paediatric surgeons, 13 243 anaesthesiologists and 103 793 nurses across Brazil in 2015. The U5MR ranged from 11 to 26 deaths/1000 live births and the POMR ranged from 0.11-0.17 deaths/100 000 children across the country. The surgical workforce is inequitably distributed across the country, with the wealthier South and Southeast regions having a higher workforce density as well as lower U5MR than the poorer North and Northeast regions. Using linear regression, we found an inverse relationship between the surgical workforce density and U5MR. An U5MR of 15 deaths/1000 births across Brazil is associated with a workforce level of 5 paediatric surgeons, 200 surgeons, 100 anaesthesiologists or 700 nurses/100 000 children. CONCLUSIONS We found wide disparities in the surgical workforce and childhood mortality across Brazil, with both directly related to socioeconomic status. Areas of increased surgical workforce are associated with lower U5MR. Strategic investment in the surgical workforce may be required to attain optimal health outcomes for children in Brazil, particularly in rural regions.
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Affiliation(s)
| | - Joao Vissoci
- Duke University Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nubia Rocha
- Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Dan Poenaru
- Pediatric Surgery, Montreal Children\'s Hospital Research Institute, Montreal, Quebec, Canada
| | - Mark Shrime
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otology and Laryngology and Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Emily R Smith
- Duke University Global Health Institute, Duke University, Durham, North Carolina, USA
- Health, Human Performance, and Recreation, Baylor University, Waco, Texas, USA
| | - Henry E Rice
- Duke University Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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