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Development and validation of a structured observation scale to measure responsiveness of physicians in rural Bangladesh

Mar, 21/11/2017 - 00:00
Abstract Background

Responsiveness of physicians is the social actions that physicians do to meet the legitimate expectations of service seekers. Since there is no such scale, this study aimed at developing one for measuring responsiveness of physicians in rural Bangladesh, by structured observation method.

Methods

Data were collected from Khulna division of Bangladesh, through structured observation of 393 patient-consultations with physicians. The structured observation tool consisted of 64 items, with four Likert type response categories, each anchored with a defined scenario. Inter-rater reliability was assessed by same three raters observing 30 consultations. Data were analyzed by exploratory factor analysis (EFA), followed by assessment of internal consistency by ordinal alpha coefficient, inter-rater reliability by intra-class correlation coefficient (ICC), concurrent validity by correlating responsiveness score with waiting time, and known group validity by comparing public and private sector physicians.

Results

After removing items with more than 50% missing values, 45 items were considered for EFA. Parallel analysis suggested a 5-factor model. Nine items were removed from the list owing to < 0.50 communality, <0.32 loading in un-rotated matrix, and <0.30 on any factor in rotated matrix. Since 34 items (i.e., the number of remaining items after removing nine items by EFA) were loaded neatly under five factors, explained 61.38% of common variance, and demonstrated high internal consistency with coefficient of 0.91, this was adopted as the Responsiveness of Physicians Scale (ROP-Scale). The five factors were named as 1) Friendliness, 2) Respecting, 3) Informing and guiding, 4) Gaining trust, and 5) Financial sensitivity. Inter-rater reliability was high, with an ICC of 0.64 for individual rater’s reliability and 0.84 for average reliability scores. Positive correlation with waiting time (0.51), and higher score of private sector by 0.18 point denote concurrent, and known group validity, respectively.

Conclusions

The ROP-Scale consists of 34 items grouped under five factors. One can apply this with confidence in comparable settings, as this scale demonstrated high internal consistency and inter-rater reliability. More research is needed to test this scale in other settings and with other types of providers.

Categorías: Investigaciones

Burden of musculoskeletal disorders among registered nurses: evidence from the Thai nurse cohort study

Mar, 21/11/2017 - 00:00
Abstract Background

Musculoskeletal disorders (MSDs) are a major public health problem among registered nurses (RNs) in Thailand. Information on their burdens at a national level is limited. This study estimated the prevalence of MSDs among RNs using the 2009 Thai Nurse Cohort, a nationally representative sample of RNs in Thailand.

Methods

This study is part of the first wave survey of the Thai Nurse Cohort Study (TNCS) conducted in 2009. Members of the cohort consisted of 18,756 RNs across Thailand. A 13-page self-administered questionnaire was sent to participants where MSDs were measured by self-reported answers to questions related to experiencing MSDs during a previous year. However, 1070 RNs were excluded from this study since they were unemployed during a previous year, therefore the final sample size was 17,686 RNs. A 12-month prevalence of MSDs and its 95% confidence interval (95% CI) were estimated based on normal approximation to binomial distribution. Chi-square test for trend was used.

Results

Of the 17,686 RNs, 47.8% (95% CI: 47.0–48.5) reported having MSDs during the previous 12 months. The prevalence of MSDs significantly increased with age, body mass index, and working duration (all P < 0.001). Compared to the non-MSD group, RNs with MSDs had a higher proportion who perceived MSDs as a long-term, chronic medical condition (78.1% vs 20.7%; p < 0.001), being currently on medication (49.4% vs 14.7%; p < 0.001), using pain relief medication almost every day (9.0% vs 1.9%; p < 0.001), experiencing sickness absence (15.7% vs 1.1%; p < 0.001), seeking medical specialist consultations (odds ratio, OR 2.2; 95% CI: 2.0–2.3; p < 0.001), and seeking alternative medications (OR 2.5; 95% CI: 2.3–2.7; p < 0.001).

Conclusions

Musculoskeletal disorders affected almost half of the RNs in Thailand annually. They placed a major healthcare burden and were a major cause of working days lost due to sick leaves, diminished productivity and quality of patient care. More attention should be paid to the prevention and effective management of MSDs in RNs in Thailand. Further study on ergonomics related to MSDs and its prevention are needed.

Categorías: Investigaciones

Situational analysis to inform development of primary care and community-based mental health services for severe mental disorders in Nepal

Mié, 15/11/2017 - 00:00
Abstract Background

Nepal is representative of Low and Middle Income Countries (LMIC) with limited availability of mental health services in rural areas, in which the majority of the population resides.

Methods

This formative qualitative study explores resources, challenges, and potential barriers to the development and implementation of evidence-based Comprehensive Community-based Mental Health Services (CCMHS) in accordance with the mental health Gap Action Programme (mhGAP) for persons with severe mental health disorders and epilepsy. Focus Group Discussions (FGDs, n = 9) and Key-Informant Interviews (KIIs, n = 26) were conducted in a rural district in western Nepal. Qualitative data were coded using the Framework Analysis Method employing QSR NVIVO software.

Results

Health workers, general community members, and persons living with mental illness typically attributed mental illness to witchcraft, curses, and punishment for sinful acts. Persons with mental illness are often physically bound or locked in structures near their homes. Mental health services in medical settings are not available. Traditional healers are often the first treatment of choice. Primary care workers are limited both by lack of knowledge about mental illness and the inability to prescribe psychotropic medication. Health workers supported upgrading their existing knowledge and skills through mhGAP resources. Health workers lacked familiarity with basic computing and mobile technology, but they supported the introduction of mobile technology for delivering effective mental health services. Persons with mental illness and their family members supported the development of patient support groups for collective organization and advocacy. Stakeholders also supported development of focal community resource persons to aid in mental health service delivery and education.

Conclusion

Health workers, persons living with mental illness and their families, and other stakeholders identified current gaps and barriers related to mental health services. However, respondents were generally supportive in developing community-based care in rural Nepal.

Categorías: Investigaciones

Assessing the health workforce implications of health policy and programming: how a review of grey literature informed the development of a new impact assessment tool

Jue, 09/11/2017 - 00:00
Abstract Background

In their adoption of WHA resolution 69.19, World Health Organization Member States requested all bilateral and multilateral initiatives to conduct impact assessments of their funding to human resources for health. The High-Level Commission for Health Employment and Economic Growth similarly proposed that official development assistance for health, education, employment and gender are best aligned to creating decent jobs in the health and social workforce. No standard tools exist for assessing the impact of global health initiatives on the health workforce, but tools exist from other fields. The objectives of this paper are to describe how a review of grey literature informed the development of a draft health workforce impact assessment tool and to introduce the tool.

Method

A search of grey literature yielded 72 examples of impact assessment tools and guidance from a wide variety of fields including gender, health and human rights. These examples were reviewed, and information relevant to the development of a health workforce impact assessment was extracted from them using an inductive process.

Results

A number of good practice principles were identified from the review. These informed the development of a draft health workforce impact assessment tool, based on an established health labour market framework. The tool is designed to be applied before implementation. It consists of a relatively short and focused screening module to be applied to all relevant initiatives, followed by a more in-depth assessment to be applied only to initiatives for which the screening module indicates that significant implications for HRH are anticipated. It thus aims to strike a balance between maximising rigour and minimising administrative burden.

Conclusion

The application of the new tool will help to ensure that health workforce implications are incorporated into global health decision-making processes from the outset and to enhance positive HRH impacts and avoid, minimise or offset negative impacts.

Categorías: Investigaciones

Managing intra-EU mobility—do WHO principles of ethical recruitment have relevance?

Jue, 09/11/2017 - 00:00
Abstract Background

The WHO Global Code of Practice on the International Recruitment of Health Personnel provides for guidance in health workforce management and cooperation in the international context. This article aims to examine whether the principles of the voluntary WHO Global Code of Practice can be applied to trigger health policy decisions within the EU zone of free movement of persons.

Methods

In the framework of the Joint Action on European Health Workforce Planning and Forecasting project (Grant Agreement: JA EUHWF 20122201 (see healthworkforce.eu)), focus group discussions were organised with over 30 experts representing ministries, universities and professional and international organisations. Ideas were collected about the applicability of the principles and with the aim to find EU law compatible, relevant solutions using a qualitative approach based on a standardised, semi-structured interview guide and pre-defined statements.

Results

Based on implementation practices summarised, focus group experts concluded that positive effects of adhering to the Code can be identified and useful ideas—compatible with EU law—exist to manage intra-EU mobility. The most relevant areas for intervention include bilateral cooperations, better use of EU financial resources, improved retention and integration policies and better data flow and monitoring.

Improving retention is of key importance; however, ethical considerations should also apply within the EU. Compensation of source countries can be a solution to further elaborate on when developing EU financial mechanisms. Intra-EU circular mobility might be feasible and made more transparent if directed by tailor-made, institutional-level bilateral cooperations adjusted to different groups and profiles of health professionals. Integration policies should be improved as discrimination still exists when offering jobs despite the legal environment facilitating the recognition of professional qualifications. A system of feedback on registration/licencing data should be promoted providing for more evidence on intra-EU mobility and support its management.

Conclusions

Workforce planning in EU Member States can be supported, and more equitable distribution of the workforce can be provided by building policy decisions on the principles of the WHO Code. Political commitment has to be strengthened in EU countries to adopt implementation solutions for intra-EU problems. Long-term benefits of respecting global principles of the Code should be better demonstrated in order to incentivise all parties to follow such long-term objectives.

Categorías: Investigaciones

Bridging the human resource gap in surgical and anesthesia care in low-resource countries: a review of the task sharing literature

Mar, 07/11/2017 - 00:00
Abstract

Task sharing, the involvement of non-specialists (non-physician clinicians or non-specialist physicians) in performing tasks originally reserved for surgeons and anesthesiologists, can be a potent strategy in bridging the vast human resource gap in surgery and anesthesia and bringing needed surgical care to the district level especially in low-resource countries. Although a common practice, the idea of assigning advanced tasks to less-specialized workers remains a subject of controversy. In order to optimize its benefits, it is helpful to understand the current task sharing landscape, its challenges, and its promise.

We performed a literature review of PubMed, EMBASE, and gray literature sources for articles published between January 1, 1996, and August 1, 2016, written in English, with a focus on task sharing in surgery or anesthesia in low-resource countries. Gray literature sources are defined as articles produced outside of a peer-reviewed journal. We sought data on the nature and forms of task sharing (non-specialist cadres involved, surgical/anesthesia procedures shared, approaches to training and supervision, and regulatory and other efforts to create a supportive environment), impact of task sharing on delivery of surgical services (effect on access, acceptability, cost, safety, and quality), and challenges to successful implementation.

We identified 40 published articles describing task sharing in surgery and anesthesia in 39 low-resource countries in Africa and Asia. All countries had a cadre of non-specialists providing anesthesia services, while 13 had cadres providing surgical services. Six countries had non-specialists performing major procedures, including Cesarean sections and open abdominal surgeries. While most cadres were recognized by their governments as service providers, very few had scopes of practice that included task sharing of surgery or anesthesia.

Key challenges to effective task sharing include specialists’ concern about safety, weak training strategies, poor or unclear career pathways, regulatory constraints, and service underutilization. Concrete recommendations are offered.

Categorías: Investigaciones

Factors Predicting Ethiopian Anesthetists’ Intention to Leave Their Job

Lun, 06/11/2017 - 00:00
Abstract Background

Ethiopia has rapidly expanded training programs for associate clinician anesthetists in order to address shortages of anesthesia providers. However, retaining them in the public health sector has proven challenging. This study aimed to determine anesthetists’ intentions to leave their jobs and identify factors that predict turnover intentions.

Methods

A nationally representative, cross-sectional survey of 251 anesthetists working in public-sector hospitals in Ethiopia was conducted in 2014. Respondents were asked whether they planned to leave the job in the next year and what factors they considered important when making decisions to quit. Bivariate and multivariable logistic regressions were conducted to investigate 16 potential predictors of turnover intentions, including personal and facility characteristics as well as decision-making factors.

Results

Almost half (n = 120; 47.8%) of anesthetists planned to leave their jobs in the next year, and turnover intentions peaked among those with 2–5 years of experience. Turnover intentions were not associated with the compulsory service obligation. Anesthetists rated salary and opportunities for professional development as the most important factors in decisions to quit. Five predictors of turnover intentions were significant in the multivariable model: younger age, working at a district rather than regional or referral hospital, the perceived importance of living conditions, opportunities for professional development, and conditions at the workplace.

Conclusions

Human resources strategies focused on improving living conditions for anesthetists and expanding professional development opportunities may increase retention. Special attention should be focused on younger anesthetists and those posted at district hospitals.

Categorías: Investigaciones

Oral primary care: an analysis of its impact on the incidence and mortality rates of oral cancer

Lun, 30/10/2017 - 00:00
Abstract Background

Oral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. In Brazil, the primary health care (PHC) system is responsible for promoting oral health in order to prevent oral diseases. However, there is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables.

Methods

An ecological, longitudinal and analytical study was carried out. Data were obtained from different secondary data sources, including three surveys that were nationally representative of Brazilian PHC and carried out over the course of 10 years (2002–2012). Data were aggregated at the state level at different times. Oral cancer incidence and mortality rates, standardized by age and gender, served as the dependent variables. Covariables (sociodemographic, structure of basic health units, and work process in oral health) were entered in the regression models using a hierarchical approach based on a theoretical model. Analysis of mixed effects with random intercept model was also conducted (alpha = 5%).

Results

The oral cancer incidence rate was positively association with the proportion of of adults over 60 years (β = 0.59; p = 0.010) and adult smokers (β = 0.29; p = 0.010). The oral cancer related mortality rate was positively associated with the proportion of of adults over 60 years (β = 0.24; p < 0.001) and the performance of preventative and diagnostic actions for oral cancer (β = 0.02; p = 0.002). Mortality was inversely associated with the coverage of primary care teams (β = −0.01; p < 0.006) and PHC financing (β = −0.52−9; p = 0.014).

Conclusions

In Brazil, the PHC structure and work processes have been shown to help reduce the mortality rate of oral cancer, but not the incidence rate of the disease. We recommend expanding investments in PHC in order to prevent oral cancer related deaths.

Categorías: Investigaciones

Improving oxygen therapy for children and neonates in secondary hospitals in Nigeria: study protocol for a stepped-wedge cluster randomised trial

Vie, 27/10/2017 - 00:00
Abstract Background

Oxygen is a life-saving, essential medicine that is important for the treatment of many common childhood conditions. Improved oxygen systems can reduce childhood pneumonia mortality substantially. However, providing oxygen to children is challenging, especially in small hospitals with weak infrastructure and low human resource capacity.

Methods/design

This trial will evaluate the implementation of improved oxygen systems at secondary-level hospitals in southwest Nigeria. The improved oxygen system includes: a standardised equipment package; training of clinical and technical staff; infrastructure support (including improved power supply); and quality improvement activities such as supportive supervision. Phase 1 will involve the introduction of pulse oximetry alone; phase 2 will involve the introduction of the full, improved oxygen system package. We have based the intervention design on a theory-based analysis of previous oxygen projects, and used quality improvement principles, evidence-based teaching methods, and behaviour-change strategies.

We are using a stepped-wedge cluster randomised design with participating hospitals randomised to receive an improved oxygen system at 4-month steps (three hospitals per step). Our mixed-methods evaluation will evaluate effectiveness, impact, sustainability, process and fidelity. Our primary outcome measures are childhood pneumonia case fatality rate and inpatient neonatal mortality rate. Secondary outcome measures include a range of clinical, quality of care, technical, and health systems outcomes. The planned study duration is from 2015 to 2018.

Discussion

Our study will provide quality evidence on the effectiveness of improved oxygen systems, and how to better implement and scale-up oxygen systems in resource-limited settings. Our results should have important implications for policy-makers, hospital administrators, and child health organisations in Africa and globally.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN12617000341325. Retrospectively registered on 6 March 2017.

Categorías: Investigaciones

Disease control programme support costs: an update of WHO-CHOICE methodology, price databases and quantity assumptions

Jue, 26/10/2017 - 00:00
Abstract Background

Estimating health care costs, either in the context of understanding resource utilization in the implementation of a health plan, or in the context of economic evaluation, has become a common activity of health planners, health technology assessment agencies and academic groups. However, data sources for costs outside of direct service delivery are often scarce. WHO-CHOICE produces global price databases and guidance on quantity assumptions to support country level costing exercises. This paper presents updates to the WHO-CHOICE methodology and price databases for programme costs.

Methods

We collated publicly available databases for 14 non-traded cost variables, as well as a set of traded items used within health systems (traded goods are those which can be purchased from anywhere in the world, whereas non-traded goods are those which must be produced locally, such as human resources). Within each of the variables, missing data was present for some proportion of the WHO member states. For each variables statistical or econometric models were used to model prices for each of the 194 WHO member states in 2010 International Dollars. Literature reviews were used to update quantity assumptions associated with each variable to contribute to the support costs of disease control programmes.

Results

A full database of prices for disease control programme support costs is available for country-specific costing purposes. Human resources are the largest driver of disease control programme support costs, followed by supervision costs.

Conclusions

Despite major advances in the availability of data since the previous version of this work, there are still some limitations in data availability to respond to the needs of those wishing to develop cost and cost-effectiveness estimates. Greater attention to programme support costs in cost data collection activities would contribute to an understanding of how these costs contribute to quality of health service delivery and should be encouraged.

Categorías: Investigaciones

Is there a financial incentive to immigrate? Examining of the health worker salary gap between India and popular destination countries

Jue, 19/10/2017 - 00:00
Abstract Background

International migration is one of the factors resulting in the shortage of Human Resources for Health (HRH) in India. Literature suggests that migration is fuelled by the prospect of higher salaries available abroad. The extent of these salary differentials are unknown, and this study seeks to examine the salaries of selected HRH in India and four popular destination countries (United States of America, United Kingdom, Canada and the United Arab Emirates), whilst accounting for the in-country cost of living. This study will therefore determine truer financial incentives for Indian HRH to migrate abroad.

Methods

A purchasing power parity (PPP) ratio is employed to equalise the international price of buying a representative basket of commonly bought goods (including food, entertainment, fuel and utilities). Using the PPP index, real differences in salaries are directly compared for selected work categories and different levels of work experience in the four respective countries.

Results

Nurses in the USA can earn up to 82.7% more than their Indian counterparts. Nurses in Canada and the UAE reveal more modest salary differentials, yet still significant better off by up to 28 and 20% respectively. Only nurses in the UK are potentially materially worse off than nurses working in India. We observe significant potential PPP gains of up to 57.4, 99.1 and 94.4% for medical doctors in the USA, Canada and the UAE respectively. Medical specialists potentially experience the greatest income disparities with anaesthetists potentially earning up to 600% more than their counterparts in India. Radiologists operating in the UK and general surgeons working in the USA can potentially earn more than double that of their counterparts working in India. We observe more modest positive or negligible PPP gains in other selected countries for health specialists.

Conclusion

Even when considering the differences in the cost of living, the financial incentive for selected cadres of Indian HRH to seek work abroad remains strong. The migration of Indian HRH to countries offering superior salaries makes it difficult for India to retain experienced health personal and compromises government efforts to render health care more accessible across the country.

Categorías: Investigaciones

Family effects on the rurality of GP’s work location: a longitudinal panel study

Jue, 19/10/2017 - 00:00
Abstract Background

Reduced opportunities for children’s schooling and spouse’s/partner’s employment are identified internationally as key barriers to general practitioners (GPs) working rurally. This paper aims to measure longitudinal associations between the rurality of GP work location and having (i) school-aged children and (ii) a spouse/partner in the workforce.

Methods

Participants included 4377 GPs responding to at least two consecutive annual surveys of the Medicine in Australia: Balancing Employment and Life (MABEL) national longitudinal study between 2008 and 2014. The main outcome, GP work location, was categorised by remoteness and population size. Five sequential binary school-age groupings were defined according to whether a GP had no children, only preschool children (aged 0–4 years), at least one primary-school child (aged 5–11 years), at least one child in secondary school (aged 12–18 years), and all children older than secondary school (aged ≥ 19). Partner in the workforce was defined by whether a GP had a partner who was either currently working or looking for work, or not. Separate generalised estimating equation models, which aggregated consecutive annual observations per GP, tested associations between work location and (i) educational stages and (ii) partner employment, after adjusting for key covariates.

Results

Male GPs with children in secondary school were significantly less likely to work rurally (inclusive of > 50 000 regional centres through to the smallest rural towns of < 5000) compared to male GPs with children in primary school. In contrast, female GPs’ locations were not significantly associated with the educational stage of their children. Having a partner in the workforce was not associated with work location for male GPs, whereas female GPs with a partner in the workforce were significantly less likely to work in smaller rural/remote communities (< 15 000 population).

Conclusions

This is the first systematic, national-level longitudinal study showing that GP work location is related to key family needs which differ according to GP gender and educational stages of children. Such non-professional factors are likely to be dynamic across the GP’s lifespan and should be regularly reviewed as part of GP retention planning. This research supports investment in regional development for strong local secondary school and partner employment opportunities.

Categorías: Investigaciones

Neuroscience in Nigeria: the past, the present and the future

Lun, 09/10/2017 - 00:00
Abstract

The science of the brain and nervous system cuts across almost all aspects of human life and is one of the fastest growing scientific fields worldwide. This necessitates the demand for pragmatic investment by all nations to ensure improved education and quality of research in Neurosciences. Although obvious efforts are being made in advancing the field in developed societies, there is limited data addressing the state of neuroscience in sub-Saharan Africa. Here, we review the state of neuroscience development in Nigeria, Africa’s most populous country and its largest economy, critically evaluating the history, the current situation and future projections. This review specifically addresses trends in clinical and basic neuroscience research and education. We conclude by highlighting potentially helpful strategies that will catalyse development in neuroscience education and research in Nigeria, among which are an increase in research funding, provision of tools and equipment for training and research, and upgrading of the infrastructure at hand.

Categorías: Investigaciones

A scoping review of mentorship of health personnel to improve the quality of health care in low and middle-income countries

Mar, 03/10/2017 - 00:00
Abstract Background

Most Low and Middle-Income Countries are facing a crisis in human resources for health which compromises their ability to meet health related targets outlined by the Sustainable Development Goals. The crisis is not limited to the availability of health personnel but also the quality of care and the training and development of the workforce. To address these challenges, evidence based education strategies are urgently required. Mentorship has been found to improve health personnel performance in High-Income Countries however, little is known about its role in Low and Middle-Income Countries. To address this gap in understanding, we conducted a scoping review of the current literature.

Methods

CINAHL, EMBASE and OVID Medline were systematically searched along with grey literature for peer-reviewed research papers specific to the research question. A six-step scoping review framework was utilised to identify the relevant literature and summarise the pertinent findings.

Results

The initial search identified 592 records, and five papers, reporting on four studies, were retained for data charting and extraction. All four studies described a positive effect of mentorship on the quality of care outcomes. The results are collated according to features of the intervention including mentor training, mentor-mentee ratios, mentorship model, intervention intensity and key findings in terms of outcome measures.

Conclusions

This review identifies a paucity of evidence of mentorship in this context however, current evidence supports the assertion that effective mentorship contributes to the improvement of certain quality of care outcomes. The features of successful mentorship interventions are outlined and the implications are discussed in the context of existing evidence.

Categorías: Investigaciones

Opportunities for human resources for health and rehabilitation: a response to Jesus et al.

Sáb, 30/09/2017 - 00:00
Abstract

We welcome Jesus et al.’s paper, which makes an important contribution to the under-researched area of the physical rehabilitation workforce. The authors present recommendations to “advance a policy and research agenda for ensuring that an adequate rehabilitation workforce can meet the current and future rehabilitation health needs” (p. 1). We argue that their perspective could however be strengthened by adopting a stronger global perspective, including consideration of the needs of low-resource settings. In particular, we highlight the integral role of more effective sector and inter-sectoral governance, the opportunity to support the development of community-based rehabilitation (CBR), the lessons that can be learnt from human resources for health (HRH) research and practice more generally, and the recent developments in the global provision of assistive technologies. Each of these issues has important implications and contributions to make to advance the policy and research agenda for the global rehabilitation workforce.

Categorías: Investigaciones

Perspectives and experiences of community health workers in Brazilian primary care centers using m-health tools in home visits with community members

Vie, 29/09/2017 - 00:00
Abstract Background

Mobile health (m-health) tools are a promising strategy to facilitate the work of community health workers (CHWs) in low- and middle-income countries (LMICs). Despite their potential value, little is known about CHWs’ experiences working with m-health tools in their outreach activities with community members.

Methods

To understand the benefits of and barriers to using m-health tools for CHWs, we conducted semi-structured interviews with 57 CHWs employed in six primary care centers in São Paulo, Brazil. All CHWs had experience using a cell phone application called Geohealth for collecting health and demographic data of community members. We assessed their experiences using Geohealth and recommendations for improvements.

Results

CHWs described key benefits of using Geohealth as helping them save time with bureaucratic paperwork, organizing the data that they needed to collect, and by replacing sheaves of paper, reducing the weight that they carried in the field. However, there were many technical and social barriers to the successful adoption of the m-health tool. Key among these were poor quality hardware, faulty software programs, and negative community member perceptions of the m-health program. The CHWs provided valuable input as to how Geohealth could be improved to fit their needs.

Conclusion

m-health tools have the potential to facilitate the work of CHWs in LMICs. However, such tools must be designed and implemented thoughtfully. Technical barriers related to both hardware and software must be anticipated and addressed to maximize their efficiency and successful adoption. CHW input on the design of the tool should be sought to maximize its utility and minimize barriers to use.

Categorías: Investigaciones

One Health/EcoHealth capacity building programs in South and South East Asia: a mixed method rapid systematic review

Vie, 29/09/2017 - 00:00
Abstract Background

Although One Health (OH) or EcoHealth (EH) have been acknowledged to provide comprehensive and holistic approaches to study complex problems, like zoonoses and emerging infectious diseases, there remains multiple challenges in implementing them in a problem-solving paradigm. One of the most commonly encountered barriers, especially in low- and middle-income countries, is limited capacity to undertake OH/EH inquiries. A rapid review was undertaken to conduct a situation analysis of the existing OH/EH capacity building programs, with a focused analysis of those programs with extensive OH engagement, to help map the current efforts in this area.

Methods

A listing of the OH/EH projects/initiatives implemented in South Asia (SA) and South East Asia (SEA) was done, followed by analysis of documents related to the projects, available from peer-reviewed or grey literature sources. Quantitative data was extracted using a data extraction format, and a free listing of qualitative themes was undertaken.

Results

In SEA, 13 unique OH/EH projects, with 37 capacity building programs, were identified. In contrast, in SA, the numbers were 8 and 11 respectively. In SA, programs were oriented to develop careers in program management, whereas, in SEA, the emphasis was on research. Two thirds of the programs in SEA had extensive OH engagement, whereas only one third of those in SA did. The target for the SEA programs was wider, including a population more representative of OH stakes. SEA program themes reveal utilization of multiple approaches, usually in shorter terms, and are growing towards integration with the traditional curricula. Such convergence of themes was lacking in SA programs. In both regions, the programs were driven by external donor agencies, with minimal local buy-in.

Conclusions

There is limited investment in research capacity building in both SA and SEA. The situation appears to be more stark in SA, whilst SEA has been able to use the systematic investment and support to develop the OH/EH agenda and strategize capacity building in the core competencies. In order to effectively address the disease emergence hotspots in these regions, there needs to be strategic funding decisions targeting capacity building in the core OH/EH competencies especially related to transdisciplinarity, systems thinking, and adaptive management.

Categorías: Investigaciones

A case study on building capacity to improve clinical mentoring and maternal child health in rural Tanzania: the path to implementation

Mar, 26/09/2017 - 00:00
Abstract Background

Tanzania is a low income, East African country with a severe shortage of human resources for health or health workers. This shortage threatens any gains the country is making in improving maternal health outcomes. This paper describes a partnership between Touch Foundation and NYU Rory Meyers College of Nursing - Global, aimed at improving clinical mentorship and capacity among nurses and midwives at two rural hospitals in the Tanzanian Lake Zone Region. Clinical mentoring capacity building and supportive supervision of staff has been shown to be a facilitator of retaining nurses and would be possible to acquire and implement quickly, even in a context of low resources and limited technology.

Methods

A case study approach structures this program implementation analysis. The NYU Meyers team conducted a 6-day needs assessment at the two selected hospitals. A SWOT analysis was performed to identify needs and potential areas for improvement. After the assessment, a weeklong training, tailored to each hospitals’ specific needs, was designed and facilitated by two NYU Meyers nursing and midwifery education specialists. The program was created to build on the clinical skills of expert nurse and midwife clinicians and suggested strategies for incorporating mentoring and preceptorship as a means to enhance clinical safety and promote professional communication, problem solving and crisis management.

Results

Nineteen participants from both hospitals attended the training. Fourteen of 19 participants completed a post training, open ended questionnaire for a 74% response rate. Fifty-seven percent of participants were able to demonstrate and provide examples of the concepts of mentorship and supervision 4 and 11 months’ post training. Participants indicated that while confidence in skills was not lacking, barriers to quality care lay mostly in understaffing. Implementation also offered multiple insights into contextual factors affecting sustainable program implementation.

Conclusions

Three recommendations from this training include: 1) A pre-program assessment should be conducted to ascertain contextual relevance to curriculum development; 2) flexibility and creativity in teaching methods are essential to engage students; and 3) access to participants a priori to program implementation may facilitate a more tailored approach and lead to greater participant engagement.

Categorías: Investigaciones

Factors influencing trainee doctor emigration in a high income country: a mixed methods study

Lun, 25/09/2017 - 00:00
Abstract Background

The Global Code of Practice on the International Recruitment of Health Personnel focuses particularly on migration of doctors from low- and middle-income countries. Less is understood about migration from high-income countries. Recession has impacted several European countries in recent years, and in some cases emigration has reached unprecedented levels. This study measures and explores the predictors of trainee doctor emigration from Ireland.

Methods

Using a partially mixed sequential dominant (quantitative) study design, a nationally representative sample of 893 trainee doctors was invited to complete an online survey. Of the 523 who responded (58.6% response rate), 423 were still in Ireland and responded to questions on factors influencing intention to practice medicine abroad and are the subjects of this study. Explanatory factors for intention to practice medicine in Ireland in the foreseeable future, the primary outcome, included demographic variables and experiences of working within the Irish health system. Associations were examined using univariable and multivariable logistic regression to estimate odds ratios for factors influencing the primary outcome. Qualitative interviews were conducted with 50 trainee doctors and analysed thematically, exploring issues associated with intention to practice medicine abroad.

Results

There were high levels of dissatisfaction among trainee doctors around working conditions, training and career progression opportunities in Ireland. However, most factors did not discriminate between intention to leave or stay. Factors that did predict intention to leave included dissatisfaction with one’s work-life balance (odds ratio (OR) 2.51; 95% confidence interval (CI) 1.53–4.10; P < 0.001); feeling that the quality of training in Ireland was poor (OR 1.82; 95% CI 1.09–3.05; P = 0.002) and leaving for family or personal reasons (OR 1.85; 95% CI 1.08–3.17; P = 0.027). Qualitative findings illustrated the stress of doing postgraduate training with inadequate supervision, lack of ring-fenced training time and pressures on personal and family life.

Conclusions

Large-scale dissatisfaction with working, training and career opportunities point to systemic factors that need to be addressed by health workforce planners if Ireland is to retain and benefit from a motivated medical workforce, given trainees’ perceptions that there are better opportunities abroad.

Categorías: Investigaciones

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