How surface acting affects turnover intention among family doctors in rural China: the mediating role of emotional exhaustion and the moderating role of occupational commitment
Family doctors in rural China are the main force for primary health care, but the workforce has not been well stabilized in recent years. Surface acting is an emotional labor strategy with a disparity between inner feelings and emotional displays, provoking negative effects such as emotional exhaustion, occupational commitment reduction, and, consequently, increasing turnover rate. With the Conservation of Resources theory, this study explores how the surface acting of rural family doctors affects turnover intention through emotional exhaustion and investigates what role occupational commitment plays in this relationship.Methods
With a valid response rate of 93.89%, 953 valid data were collected by an anonymous self-administered questionnaire survey in December 2021 in Shandong Province, China. Cronbach’s Alpha and confirmatory factor analysis (CFA) were used to estimate reliability and construct validity, respectively. The PROCESS macro in SPSS was performed to analyze the mediating and moderated mediation effects of surface acting, emotional exhaustion, occupational commitment, and turnover intention.Results
Reliability and validity indicated that the measurement instruments were acceptable. Surface acting had a direct positive effect on turnover intention (β = 0.481, 95% CI [0.420, 0.543]). Emotional exhaustion partially mediated the effect of surface acting on turnover intention (indirect effect: 0.214, 95% CI [0.175, 0.256]). Occupational commitment moderated the effect of emotional exhaustion on turnover intention (β = − 0.065, 95% CI [− 0.111, − 0.019]), and moderated the indirect effect of surface acting on turnover intention via emotional exhaustion (index of moderated mediation: − 0.035).Conclusions
Emotional exhaustion partially mediates the relationship between surface acting and turnover intention among family doctors in rural China, and occupational commitment moderates the direct effect of emotional exhaustion on turnover intention and further moderates the mediating effect. Policymakers should pay more attention to the effects of emotional labor and emotional resource depletion on the stability of rural health human resources.
An audit of the carbon footprint of travel for the Canadian Anesthesiologists’ Society International Education Foundation partnerships
International partnerships have an important role in capacity building in global health, but frequently involve travel and its associated carbon footprint. The environmental impact of global health partnerships has not previously been quantified.Methods
We conducted a retrospective internal audit of the environmental impact of air travel for the international education programs of the Canadian Anesthesiology Society’s International Education Fund (CASIEF). We compiled a comprehensive list of volunteer travel routes and used the International Civil Aviation Organization Carbon Emissions Calculator, which considers travel distance, passenger numbers, and average operational data for optimized estimates. Comparisons were made with average Canadian household emissions and disability adjusted life years (DALYs) lost from climate change consequences.Results
The total carbon dioxide emitted (CO2-e) for the Rwanda, Ethiopia, and Guyana CASIEF partnerships were 268.2, 60.7, and 52.0 tons, respectively. The DALYs cost of these programs combined is estimated to be as high as 1.1 years of life lost due to the effects of CO2-e. The mean daily carbon cost of the average Rwanda partnership was equivalent to daily emissions of 2.2 Canadians (or 383 Rwandans), for the Guyana partnership was equivalent to 1.6 Canadians (or 7.6 Guyanese people), and for the Ethiopia partnership was equivalent to 2.4 Canadians (or 252 Ethiopian people).Conclusions
Air travel from these CASIEF partnerships resulted in 380.9 tons CO2-e but also enabled 5,601 volunteer days-in-country since 2014. The estimated environmental cost needs to be balanced against the impact of the programs. Regardless, carbon-reduction remains a priority, whether by discouraging premium class travel, organizing longer trips to reduce daily emissions, prioritizing remote support and virtual education, or developing partnerships closer to home.
Complexities of health and care worker migration pathways and corresponding international reporting requirements
The increasing complexity of the migration pathways of health and care workers is a critical consideration in the reporting requirements of international agreements designed to address their impacts. There are inherent challenges across these different agreements including reporting functions that are misaligned across different data collection tools, variable capacity of country respondents, and a lack of transparency or accountability in the reporting process. Moreover, reporting processes often neglect to recognize the broader intersectional gendered and racialized political economy of health and care worker migration. We argue for a more coordinated approach to the various international reporting requirements and processes that involve building capacity within countries to report on their domestic situation in response to these codes and conventions, and internationally to make such reporting result in more than simply the sum of their responses, but to reflect cross-national and transnational interactions and relationships. These strategies would better enable policy interventions along migration pathways that would more accurately recognize the growing complexity of health worker migration leading to more effective responses to mitigate its negative effects for migrants, source, destination, and transit countries. While recognizing the multiple layers of complexity, we nevertheless reaffirm the fact that countries still have an ethical responsibility to undertake health workforce planning in their countries that does not overly rely on the recruitment of migrant health and care workers.
Assessment of integrated community case management of childhood illness (ICCM) practices by trained patent and proprietary medicine vendors (PPMVs) in Ebonyi and Kaduna states, Nigeria
An Integrated Community treatment of Childhood disease (ICCM)- focused intervention involving a large number of Patent and proprietary medicine vendors (PPMVs) was conducted by Society for Family Health Nigeria to improve management of childhood, malaria, pneumonia and diarrhea with an intervention approach focused on knowledge and skill improvement. The intervention was conducted in Kaduna and Ebonyi state; recruited and trained 15 interpersonal communication agents (IPCAs) who were saddled with the responsibility to sensitize and mobilize caregivers with children within the age bracket of 2 months to 5 years to our mapped PPMVs within the communities, on the account of Malaria, Diarrhea, and Pneumonia; while the IPCAs in return monitor the quality-of-service delivery. Following the intervention, the Society for Family health conducted a study to demonstrate the effectiveness of interventions such as ICCM training, supervision and linkage to quality ICCM commodities, among PPMVs to achieve high levels of knowledge and performance in diagnosing and treating common childhood illnesses.Methods
Longitudinal research (before and after study) was adopted for the study. From the 387 PPMVs recruited and trained by SFH, 165 PPMVs were systematically selected to participate in the study, before and after the implementation of the intervention. Using SPSS version 22, data from the observation and completed questionnaires were analyzed and a chi-square test was used to examine the associations between the categorical information collected prior and after the intervention. The analysis was conducted at 5% level of significance.Results
More than 50 % of the study participants were females (56.4%) and majority were either Junior community extension workers (35%) or Senior community extension worker (27%). About 21.8% trained PPMVs could not appropriately treat malaria in the first quarter of the intervention, however, there was a significant decrease to 1.8% in second quarter in the number of those that cannot appropriately diagnose and treat malaria. There was also a decrease in the number of those who could not treat cough and fast breathing from 47(28.5%) to 14(8.5%) in the second quarter and for diarrhea from 33.3% in the first quarter to 2.4% in the second quarter.Conclusion
The study revealed a significant improvement in the quality of treatment provided by the trained PPMVs across the three disease areas. PPMVs in hard-to-reach areas should be trained and supported to continuously provide quality services to change the indices of under-5 mortality in Nigeria.
"They are gaining experience; we are gaining extra hands": a mixed methods study to assess healthcare worker perceptions of a novel strategy to strengthen human resources for HIV in South Africa.
Assessment of Staffing Needs for Frontline Health Workers in Selected Maternal and Child Health Services in 3 Countries of Sub-Saharan West Africa: Cote d'Ivoire, Burkina Faso, and Niger.
Physician emigration from Nigeria and the associated factors: the implications to safeguarding the Nigeria health system.
Determining staffing needs for improving primary health care service delivery in Kaduna State, Nigeria.
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.
There is a strong and wide consensus that Pakistan must pursue universal health coverage (UHC) attainment as the driving force for achieving sustainable development goals by 2030. Nevertheless, several institutional and socioeconomic challenges may hinder the progress toward UHC.Main body
It is important that the health system of Pakistan must be transformed to strengthen all three dimensions of UHC i.e. maximizing the population covered, increasing the range of services offered, and reducing the cost-sharing. To make UHC dream a reality in Pakistan, there are some pre-requisites to meet upfront: a) budgetary allocation for health as percentage of GDP must be increased; b) health system’s readiness especially in the public sector ought to improve in terms of human resource and availability of essential services; c) safety nets for health must continue regardless of the change in the political regimes; d) decrease the reliance on donors’ funding; and e) accountability to be ensured across the board for service providers, managers, administrators and policymakers in the health system.Conclusion
COVID-19 pandemic has revealed some major gaps in the health system’s capacity to deliver equitable healthcare, which is a cornerstone to achieving the UHC agenda. The priority-setting process will need to be aligned with the SDGs to ensure that the agenda for action towards 2030 is comprehensively addressed and successfully accomplished preferably before, but hopefully not beyond the targeted dates.
“They are gaining experience; we are gaining extra hands”: a mixed methods study to assess healthcare worker perceptions of a novel strategy to strengthen human resources for HIV in South Africa
Lay health workers (LHWs) can support the HIV response by bridging gaps in human resources for health. Innovative strategies are needed to expand LHW programs in many low- and middle-income countries. Youth Health Africa (YHA) is a novel LHW approach implemented in South Africa that places young adults needing work experience in one-year non-clinical internships at health facilities to support HIV programs (e.g., as HIV testers, data clerks). While research suggests YHA can increase HIV service delivery, we need to understand healthcare worker perceptions to know if this is an acceptable and appropriate approach to strengthen human resources for health and healthcare delivery.Methods
We conducted a convergent mixed methods study to assess healthcare worker acceptance and perceived appropriateness of YHA as implemented in Gauteng and North West provinces, South Africa and identify issues promoting or hindering high acceptability and perceived appropriateness. To do this, we adapted the Johns Hopkins Measure of Acceptability and Appropriateness to survey healthcare workers who supervised interns, which we analyzed descriptively. In parallel, we interviewed frontline healthcare workers who worked alongside YHA interns and conducted an inductive, thematic analysis. We merged quantitative and qualitative results using the Theoretical Framework of Acceptability to understand what promotes or hinders high acceptance and appropriateness of YHA.Results
Sixty intern supervisors responded to the survey (91% response rate), reporting an average score of 3.5 for acceptability and 3.6 for appropriateness, on a four-point scale. Almost all 33 frontline healthcare workers interviewed reported the program to be highly acceptable and appropriate. Perceptions that YHA was mutually beneficial, easy to integrate into facilities, and helped facilities be more successful promoted a strong sense of acceptability/appropriateness amongst healthcare workers, but this was tempered by the burden of training interns and limited program communication. Overall, healthcare workers were drawn to the altruistic nature of YHA.Conclusion
Healthcare workers in South Africa believed YHA was an acceptable and appropriate LHW program to support HIV service delivery because its benefits outweighed its costs. This may be an effective, innovative approach to strengthen human resources for HIV services and the broader health sector.
Workload Indicators of Staffing Need (WISN) Method for Midwives Planning and Estimation at Asrade Zewude Memorial Primary Hospital, North west Ethiopia
Workforce is a crucial component of the health service delivery system. Ethiopia faces health workforce challenges when it comes to evidence based health workforce planning.
Workforce planning was initially determined by comparing the health worker ratio to the general population number. Later, it was determined by standard staffing schedules for each health facility level. However, neither of these methods addressed the evidence based workload variation issue among the same level facilities all around the country. A workload indicator of staff needs (WISN) method can address these variations. Therefore this research was carried on to determine workload pressure excess or gap in midwives, thereby to promote the WISN use in health facilities, based on WISN results of midwives at Asrade Zewude memorial Hospital.Methods
A cross sectional study using WISN model was used to determine the workload excess and gap pressure in midwives at Asrade Zewude Memorial primary hospital, North West Ethiopia. Midwives were selected based on a priority point scale as outlined in the WISN method.Results
According to the data obtained, midwives worked five days a week and 1030 h per year. This working time was spent on health service activities (58.4%), additional activities (36.6%) and support activities (5%). WISN calculations demonstrated a shortage of five midwives with WISN ratio of 0.8 at Asrade Zewude Memorial primary hospital North West Ethiopia.Conclusion
Midwives at the study area were carrying on their routine tasks even though there was a staff gap of 5: thus, the midwives had a workload excess of 20%. Under these conditions, it may be hard for the facility to achieve universal health service goals. Therefore the hospital should institutionalize WISN method planning to objectively employ midwifery professionals. This study had limitations too as it used retrospective annual service statistics and small sample size which affects generalization of the results to other health facilities and other health worker cadres within the study hospital.
Evolving insights into the epidemiology of Moraxella species bloodstream infection from two decades of surveillance in Queensland, Australia
The epidemiology of Moraxella species bloodstream infection (BSI) is poorly defined due to their rarity. We sought to determine the incidence, risk factors, and outcomes of Moraxella species BSI in a large Australian population. All Moraxella species BSIs in patients admitted to Queensland (population estimate 5 million) public health facilities between 2000 and 2019 and submitted to Queensland pathology laboratory-based surveillance were included. Clinical and hospitalisation data were matched with laboratory-based surveillance data. Incidence rate ratios (IRR) with 95% confidence intervals (CI) were calculated. In total, 375 incident Moraxella species BSI occurred during 86 million person-years of surveillance, with an annualised age and sex standardised incidence of 4.3 per million residents. Isolates were most commonly identified as M. catarrhalis (n = 128; 34%) and community-associated (n = 225; 60%). Incidence was highest in infants, with increasing age associated with lower incidence rate. Males were at higher risk (incidence 2.9 vs. 2.0 per million, IRR1.4; 95% CI, 1.2–1.8), this was most pronounced at age extremes. Two-thirds of adults and 43% of children with Moraxella BSI had at least one comorbid illness. When compared to infections in adults, children were more likely to have community-associated disease, and a head and neck source focus of infection. The all-cause 30-day case-fatality rate was 4% (15/375) and this was significantly higher among adults (14/191; 7% vs 1/183; 1%; p < 0.001). Our findings demonstrate the low burden of Moraxella species BSI in a state-wide cohort, for which young children have the highest risk.
Why are they “unreached”? Macro and Meso determinants of health care access in hard to reach areas of Odisha, India
Reaching hard to reach populations is key to reduce health inequities. Despite targeted interventions, status of crucial public health indicators like neonatal and maternal mortality is still far from optimal. Complex interplay of social determinants can influence both communities and health care workers to effectively access each other. We argue that culturally sensitive and contextually relevant healthcare provision has potential to increase health care utilization by the vulnerable communities living in remote areas.Methods
The study is an exploratory case study using rapid ethnographic techniques to understand the interplay of social determinants in hard to reach areas of Odisha state, India. We used in-depth interviews, focus group discussion, participatory action research and key informant interviews as tools for data collection. The analysis of data has been guided by thematic analysis approach.Results
We found that there are further layers within the designated hard to reach areas and those can be designated as-i) extremely remote ii) remote and iii) reachable areas. Degree of geographic difficulties and cultural dynamics are deciding the ‘perceived’ isolation and interaction with health care providers in hard to reach areas. This ultimately leads to impacting the utilization of the facilities. At extremely remote areas, felt health needs are mainly fulfilled by traditional healers and ethno-medical practices. In reachable areas, people are more prone to seek care from the public health facilities because of easy accessibility and outreach. Being in middle people in remote areas, diversify health care seeking depending upon social (e.g. patient’s gender) economic (e.g. avoid catastrophic expenditure) and health system (timely availability of health human resources, language barriers) factors.Conclusion
Our research highlights the need to value and appreciate different worldviews, beliefs and practices, and their understanding of and engagement with the pluralistic health care system around them. Other than pursuing the ‘mainstreaming’ of a standardized health system model across hard to reach areas, strategies need to be adaptive as per local factors. To handle that existing policies need revision with a focus on culturally sensitive and contextual care provision.
Mapping global evidence on public-private partnership for medical rehabilitation services delivery: a scoping review protocol
Access to medical rehabilitation remains poor in Sub-Saharan Africa. This is partly due to inadequate service delivery emanating from ill-defined public health policies. Developed countries have adopted public-private partnership (PPP) agreements between the government and private sectors, thus presenting superior quality and access to rehabilitation services. To help develop a PPP model for physiotherapy service delivery in South Africa, this scoping review will map research linked to PPP for medical rehabilitation services delivery and outcomes in the global context.Methodology
The Arksey and O’Malley (2005) framework (identify the research question, identify relevant research, select studies, chart the data, collate, summarize, and report findings) will be used to guide this review. Peer-reviewed literature will be searched in PubMed, EBSCOhost, Cochrane library, SCOPUS, and Google Scholar from 2000-2022 using a combination of keywords, Medical Subject Headings, and Boolean terms. Screening of the articles at all stages will be conducted independently by two reviewers using the eligibility criteria as a guide. The reference lists of retrieved articles will be manually searched for relevant studies. Emerging themes and sub-themes will be collated, summarized, and the results reported in the narrative form.Discussion
We anticipate identifying literature gaps for future research to inform policy on PPP for rehabilitation services delivery in Sub-Saharan Africa and actual practice. The results of this review will contribute to building a model that will enable the provision of equitable rehabilitation services at the district health level using PPP.