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Bustamante Izquierdo JP, Puertas EB, Hernández Hernández D, Sepúlveda H. COVID-19 and human resources for health: analysis of planning, policy responses and actions in Latin American and Caribbean countries. Hum Resour Health 2023; 21:21. [PMID: 36918895 PMCID: PMC10013275 DOI: 10.1186/s12960-023-00795-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/20/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to worldwide health service disruptions, due mainly to insufficient staff availability. To gain insight into policy responses and engage with policy-makers, the World Health Organization (WHO) developed a global approach to assess and measure the impact of COVID-19 on the health workforce. As part of this, WHO, together with the Pan American Health Organization (PAHO), supported an impact analysis of COVID-19 on health workers and policy responses, through country case studies in Latin America and the Caribbean (LAC). METHODS We sought to identify lessons learned from policies on human resources for health (HRH) during health emergencies, to improve HRH readiness. First, we performed a rapid literature review for information-gathering. Second, we used the WHO interim guidance and impact measurement framework for COVID-19 and HRH to systematically organize that information. Finally, we used the Health Labour Market Framework to guide the content analysis on COVID-19 response in eight LAC countries and identify lessons learned to improve HRH readiness. RESULTS Planning and implementing the COVID-19 response required strengthening HRH governance and HRH data and information systems. The results suggest two main aspects for HRH governance crucial to enabling an agile response: (1) aligning objectives among ministries to define and produce regulation and policy actions; and (2) agreeing on the strategy for HRH management between the public and private sectors, and between central and local governments. We identified three areas for improvement: (a) HRH information systems; (b) methodologies to estimate HRH needs; and (c) teams to analyse information for decision-making. Three key actions were identified during countries monitored, reviewed, and updated their response stages: (i) strengthening response through primary health care; (ii); planning HRH needs to implement the vaccination plan; and (iii) securing long-term HRH availability. CONCLUSION Countries coordinated and articulated with different stakeholders to align objectives, allocate resources, and agree on policy actions to implement the COVID-19 response. Data and information for HRH preparedness and implementation were key in enabling an agile COVID-19 response and are key areas to explore for improved pandemic preparedness.
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Affiliation(s)
- Juana Paola Bustamante Izquierdo
- Health Labour Market Unit, Health Workforce Department, Universal Health Coverage Cluster, World Health Organisation (WHO/UHC/HWF), 1211 Geneva, Switzerland
| | - E. Benjamín Puertas
- Human Resources for Health for the Sub-Regional Programme for the Caribbean, Human Resources for Health Unit, Health Systems and Services Area, Office of the Assistant Director (PAHO/AD/HSS/HR), Pan American Health (PAHO/WHO), Washington, United States of America
| | | | - Hernán Sepúlveda
- Human Resources for Health for the Sub-Regional Programme for South America, Human Resources for Health Unit (PAHO/AD/HSS/HR), Washington, United States of America
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Puertas EB, Rodríguez YS, Alvarado EM, Villanueva Y, Velasquez E, Erazo BM, Alfaro H, Dolmo CO. Career choice in primary care: pre- and post-comparison of Honduran physicians completing social service. Rev Panam Salud Publica 2017; 41:e146. [PMID: 31391835 PMCID: PMC6660855 DOI: 10.26633/rpsp.2017.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/23/2017] [Indexed: 11/20/2022] Open
Abstract
Objective. To describe and compare patterns of specialty choice among physicians in Honduras before and after completing mandatory social service; and to identify and compare salary perceptions and factors that may influence their career choice. Methods. A quantitative methods approach was used on a cross-sectional questionnaire survey applied to 106 physicians completing social service in September 2015. Statistical analysis was performed using chi-square and factor analysis. Results. Interest in family medicine was low and declined from 2.2% before social service to 0.9% after. Median annual expected income was 19.5% lower overall compared to the beginning of social service, and in particular, for primary care specialties (US$ 17 733), it was significantly lower than for other specialties (US$ 27 281). Participants reported that the most important factors influencing career choice were: income potential (23.3%), making a positive difference in people’s lives (19.4%), challenging work (10.7%), and perceived prestige (7.8%). Two factors were significantly associated with a preference for specialties other than primary care: the opportunity to teach (P= 0.008) and “makes positive difference in people’s lives“ (P = 0.005). When all categories were compared, “makes positive difference in people’s lives“ (P = 0.043), and opportunities to practice with independence (P = 0.036) were factors significantly associated to career decision. Conclusion. Since interest in primary care among physicians decreased during social service and salary perception increased in favor of non-primary care careers, offering greater incentives for this specialty should be explored. Additional research to identify factors that might support the choice of a career in primary care are recommended.
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Affiliation(s)
- E Benjamín Puertas
- Pan American Health Organization, Country Office Pan American Health Organization, Country Office Tegucigalpa Honduras Pan American Health Organization, Country Office, Tegucigalpa, Honduras
| | - Yoséf S Rodríguez
- Pan American Health Organization, Country Office Pan American Health Organization, Country Office Tegucigalpa Honduras Pan American Health Organization, Country Office, Tegucigalpa, Honduras
| | - E Mariela Alvarado
- Secretary of Health of Honduras Secretary of Health of Honduras Tegucigalpa Honduras Secretary of Health of Honduras, Tegucigalpa, Honduras
| | - Yolany Villanueva
- Secretary of Health of Honduras Secretary of Health of Honduras Tegucigalpa Honduras Secretary of Health of Honduras, Tegucigalpa, Honduras
| | - Eyvilin Velasquez
- National Autonomous University of Honduras National Autonomous University of Honduras Tegucigalpa Honduras National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Brian M Erazo
- National Autonomous University of Honduras National Autonomous University of Honduras Tegucigalpa Honduras National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Héctor Alfaro
- National Autonomous University of Honduras National Autonomous University of Honduras Tegucigalpa Honduras National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Cheny Ortiz Dolmo
- Secretary of Health of Honduras Secretary of Health of Honduras Tegucigalpa Honduras Secretary of Health of Honduras, Tegucigalpa, Honduras
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Luciano RP, Wajchenberg M, Almeida SS, Amorim CEN, Rodrigues LMR, Araujo RC, Puertas EB, Faloppa F. Genetic ACE I/D and ACTN3 R577X polymorphisms and adolescent idiopathic scoliosis. Genet Mol Res 2016; 15:gmr-15-gmr15048959. [PMID: 27819725 DOI: 10.4238/gmr15048959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The etiology of adolescent idiopathic scoliosis remains unknown. Angiotensin-converting enzyme and α-actinin-3 polymorphisms influence the characteristics of muscle fibers. The aim of this study was to examine the association between idiopathic scoliosis and genetic polymorphism of angiotensin-converting enzyme and α-actinin-3. Ninety-seven females with scoliosis, and 137 healthy, age-matched control females were studied. The presence of polymorphisms was determined by PCR. A χ2 test was used to analyze differences, and odds ratios were estimated. The frequencies of ACE genotypes in the scoliotic group were 46.4% DD, 45.4% ID, and 8.2% II, while in the control group they were 40.1% DD, 43.8% ID, and 16.1% II (P = 0.197). The D allele had a frequency of 69.1% in patients with idiopathic scoliosis and 62% in the control group (P = 0.116). The frequencies of ACTN3 genotypes in females with scoliosis were 31.8% RR, 49.4% RX, and 18.8% XX, while in the control group they were 35% RR, 49% RX, and 16% XX (P = 0.810). The frequency of the R allele was 56.4% in the scoliotic group and 59.6% in the control group (P = 0.518). There was no statistically significant association between angiotensin-converting enzyme or α-actinin-3 polymorphisms and the presence of adolescent idiopathic scoliosis in females.
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Affiliation(s)
- R P Luciano
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - M Wajchenberg
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - S S Almeida
- Departamento de Biofísica, Laboratório de Pesquisa Genética do Exercício e Metabolismo da Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - C E N Amorim
- Departamento de Biofísica, Laboratório de Pesquisa Genética do Exercício e Metabolismo da Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - L M R Rodrigues
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - R C Araujo
- Departamento de Biofísica, Laboratório de Pesquisa Genética do Exercício e Metabolismo da Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - E B Puertas
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - F Faloppa
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Puertas EB, Rivera TY. Factors that influence career choice in primary care among medical students starting social service in Honduras. Rev Panam Salud Publica 2016; 40:309-317. [PMID: 28076579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/03/2016] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To 1) describe patterns of specialty choice; 2) investigate relationships between career selection and selected demographic indicators; and 3) identify salary perception, factors that influence career choice in primary care, and factors that influence desired location of future medical practice. METHODS The study used a mixed-methods approach that included a cross-sectional questionnaire survey applied to 234 last-year medical students in Honduras (September 2014), and semi-structured interviews with eight key informants (October 2014). Statistical analysis included chi-square and factor analysis. An alpha level of 0.05 was used to determine significance. RESULTS In the qualitative analysis, several codes were associated with each other, and five major themes emerged. Primary care careers were the preferred choice for 8.1% of students, who preferred urban settings for future practice location. The perceived salary of specialties other than primary care was significantly higher than those of general practitioners, family practitioners, and pediatricians (P < 0.001). Participants considered "making a difference," income, teaching, prestige, and challenging work the most important factors influencing career choice. Practice in ambulatory settings was significantly associated with a preference for primary care specialties (P = < 0.05). Logistic regression analysis found that factors related to patient-based care were statistically significant for selecting primary care (P = 0.006). The qualitative analysis further endorsed the survey findings, identifying additional factors that influence career choice (future work option; availability of residency positions; and social factors, including violence). Rationales behind preference of a specialty appeared to be based on a combination of ambition and prestige, and on personal and altruistic considerations. CONCLUSIONS Most factors that influence primary care career choice are similar to those found in the literature. There are several factors distinctive to medical students in Honduras-most of them barriers to primary care career choice.
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Affiliation(s)
| | - Tamara Y Rivera
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
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Puertas EB, Arósquipa C, Gutiérrez D. Factors that influence a career choice in primary care among medical students from high-, middle-, and low-income countries: a systematic review. Rev Panam Salud Publica 2013; 34:351-358. [PMID: 24553763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/06/2013] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To determine which factors influence a medical student's decision to choose a career in primary care; and to establish if these factors are similar or different among students in high-, middle- and low-income countries. METHODS An extensive search was done of PubMed, Google Scholar, and Virtual Library of Health for articles on primary care careers published in 2003-2013 in English, Spanish, and/or Portuguese. Initially, 600 records were identified; 74 full-text articles were assessed for eligibility and 55 were selected (42 from high-income countries; 13 from middle- and low-income). These were assessed to identify intrinsic and extrinsic factors that influence career choice among medical students from high-, middle-, and low-income countries. RESULTS A comparison framework with common and specific factors that influence career choice in primary care among medical students from high-, middle- and low-income was developed. Factors were classified as extrinsic or intrinsic, and as facilitators or barriers. Several factors common to all countries were identified: facilitators were exposure to rural location, role models, working conditions; barriers were low income, prestige, and medical school environment. Some factors specific to middle- and low-income countries were: understanding of rural needs and intellectual challenge. Other factors specific to high-income countries were: attitude towards social problems, voluntary work, influence of family, and length of residency. CONCLUSIONS Further studies on the subject are needed, especially in low- and middle-income countries. Identifying factors as barriers or facilitators for career choice will promote a better understanding of the reasons behind the shortage of primary care professionals and will contribute to policy building, improved training, and recruitment and retention of these professionals.
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Brazil AV, Ximenes AC, Radu AS, Fernades AR, Appel C, Maçaneiro CH, Ribeiro CH, Gomes C, Meirelles ES, Puertas EB, Landin E, Egypto EJP, Appel F, Dantas FLR, Façanha FFAM, Furtado GE, Carneiro FGS, Cecin HA, Defino HL, Carrete JH, Natour J, Marques Neto JF, Amaral FJC, Provenza JR, Vasconcelos JTS, Amaral LLF, Vialle LRG, Masini M, Taricco MA, Brotto MWI, Daniel MM, Sposito M, Morais OJS, Botelho RV, Xavier RM, Radominski SC, Daher S, Lianza S, Amaral SR, Antonio SF, Barros FTE, Viana U, Vieira VP, Ferreira WHR, Stump XMG. Diagnóstico e tratamento das lombalgias e lombociatalgias. Rev Bras Reumatol 2004. [DOI: 10.1590/s0482-50042004000600005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Samara AM, Marques Neto JF, Puertas EB, Telesi E, Cruz E, Hirata ES, de Andrade DM. [Drug-induced lupus. Study in a community of mental patients]. AMB Rev Assoc Med Bras 1975; 21:12-6. [PMID: 1079354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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