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Abstract Background

A 15 million health workforce shortage is still experienced globally leading to a sub-optimal healthcare worker-to-population ratio in most countries. The use of low-skilled care assistants has been suggested as a cost-saving human resource for health strategy that can significantly reduce the risks of rationed, delayed, or missed care. However, the characterisation, role assignment, regulation, and clinical governance mechanisms for unlicensed assistive workforce remain unclear or inconsistent. The purpose of this study was to map and collate evidence of how care assistants are labelled, utilised, regulated, and managed in formal hospital settings as well as their impact on patient care.

Methods

We conducted a scoping review of literature from PUBMED, CINAHL, PsychINFO, EMBASE, Web of Science, Scopus, and Google Scholar. Searches and eligibility screening were conducted using the Participants–Context–Concepts framework. Thematic content analysis guided the synthesis of the findings.

Results

73 records from a total of 15 countries were included in the final full-text review and synthesis. A majority (78%) of these sources were from high-income countries. Many titles are used to describe care assistants, and these vary within and across countries. On ascribed roles, care assistants perform direct patient care, housekeeping, clerical and documentation, portering, patient flow management, ordering of laboratory tests, emergency response and first aid duties. Additional extended roles that require higher competency levels exist in the United States, Australia, and Canada. There is a mixture of both positive and negative sentiments on their impact on patient care or nurses’ perception and experiences. Clinical and organisational governance mechanisms vary substantially across the 15 countries. Licensure, regulatory mechanisms, and task-shifting policies are largely absent or not reported in these countries.

Conclusions

The nomenclature used to describe care assistants and the tasks they perform vary substantially within countries and across healthcare systems. There is, therefore, a need to review and update the international and national classification of occupations for clarity and more meaningful nomenclature for care assistants. In addition, the association between care assistants and care outcomes or nurses’ experience remains unclear. Furthermore, there is a dearth of empirical evidence on this topic from low- and middle-income countries.

Abstract Background

In Iran, the issue of the nursing shortage and unequal distribution exist simultaneously. The shortage of healthcare workers is one of the most important concerns of the health systems. In addition, the disparity in the distribution of healthcare workers between large metropolises and remote or non-capital areas has become a serious concern and a top priority to address. We conducted this study to identify and create a sufficient understanding of the different financial and non-financial preferences of nurses for working in deprived areas.

Methods

This research was carried out in June and April 2022. It was carried out in three major phases. The factors influencing the nurses' job preferences were first discovered using qualitative methods. The second phase was conducting a pilot study and determining the best design for discrete choice experiment scenarios. The last phase involved publishing the questionnaire to gather information. Data were analyzed (discrete choice analysis) using JMP Pro 16 software.

Results

A desirable job for the participants (nurses) in this study would have a higher salary, work in a city, the Rasmi employment contract, a low workload, adequate workplace facilities, an appropriate work schedule, and 1 to 3 years spent on the assigned job to promote to a higher position. Willingness to pay (WTP) and the probability of selecting different attribute levels were also calculated and reported. For example, the highest amount of money that a nurse expected to be paid was for changing the geographical location of the workplace from a city to a deprived area. In this case, a nurse tends to receive 91.87 million IRR more to move from a city to a deprived area to work. This amount of money was by far the most among other WTPs.

Conclusion

The results of this study indicated that nurses are willing to forego net income in exchange for other favorable characteristics of their working environment and conditions. This shows that a variety of actions are accessible to policymakers that can greatly enhance the working conditions for nurses. The WTP and the probability of selecting various attributes may help policymakers plan more effectively.

Abstract Introduction

The turnover and shortage of health care workers (HCWs) have been a worldwide problem for healthcare organizations. The primary aim of this study was to identify the factors influencing the intention of Chinese HCWs to leave their job, especially meaning in life and professional happiness.

Methods

This observational cross-sectional study, conducted among 1125 full-time HCWs, assessed demographic variables, meaning in life, professional happiness, and turnover intention by a survey. The survey was distributed to HCWs in three tertiary hospitals. The data were analyzed by T-tests, ANOVA, Kruskal–Wallis tests and hierarchical linear regression model.

Results

There were statistically significant differences in turnover intention of HCWs by gender, age, role, educational level, years in practice, and number of monthly night shifts. HCWs’ meaning in life and professional happiness were negatively associated with the turnover intention. Furthermore, after controlling for other factors, meaning in life explained 3.7% of the turnover intention and professional happiness explained 13.4%.

Conclusion

In our study, positive psychological factors were related to turnover intentions. Professional happiness was the strongest predictor. Thus, health human resource managers should foster positive psychology among HCWs to reduce their turnover.

BACKGROUND: As countries strive to achieve sustainable development goal 3.2, high-quality medical education is crucial for high-quality neonatal care. Women are encouraged to deliver in health units attended by a skilled team. Traditionally, the team is doctors and nurses, but they are members of a large group of interdependent experts from other disciplines. Each discipline trains separately, yet the goal of good neonatal care is common to all. The use of interprofessional education breaks down these professional silos improving collaborative practice and promoting excellent clinical care. Introduction of new educational materials and training requires a rigorous approach to ensure sustainability. METHODS: An extensive needs assessment identified gaps in neonatal training. Specifically, there was a lack of inclusion of medical devices used in clinical care. In each country, national key stakeholders came together to develop and revise their own neonatal curricula, trainings or guidelines. A core writing education team were tasked to develop evidence-based materials on pertinent medical devices to include in these national materials. These then underwent internal and external review. A provider course for biomedical engineers and technicians was introduced. Skills labs were established to improve practical skills teaching. To improve the quality of teaching, a NEST360 generic instructors course (GIC) was developed. RESULTS: Twenty modules, 14 scenarios, 17 job aids and 34 videos have been published to date. Materials have been embedded into neonatal curricula and national trainings. Forty-one skills labs were installed in pre-service learning institutions and, up to June 2022, have been used by 7281 students. Pre- and in-service interprofessional training was implemented at all NEST360 institutions (clinical and biomedical). GIC courses were conducted at least twice a year in all countries. Three hundred seventeen nurses, biomedical and clinical staff have undertaken the GIC in all four countries. GIC participants report that the course has very positively influenced their teaching practice. CONCLUSIONS: Inclusion of key stakeholders throughout has ensured training is embedded within the four countries. Use of interprofessional education and inclusion of biomedical engineers and technicians has been very successful. Introduction of the GIC has developed a pool of high-quality educators for neonatal care. This approach has ensured that high-quality interprofessional neonatal training is included within national agendas for neonatal care and beyond.

Introdução: Este estudo contextualiza a criação do Laboratório de Inovação na Saúde (LIS), estabelecido para integrar as entidades gestoras regionais de saúde e educação, de um estado no sul do Brasil. Considerando que inovação em saúde seja uma novidade funcional que provoca uma mudança transformadora e durável produzindo resultados significativos para a gestão do setor público. Objetivo: relatar a criação de uma organização intersetorial visando à formação profissional em saúde. Metodologia: Foram realizados encontros entre as instituições de ensino superior públicas e privadas e órgãos gestores regionais. Os encontros visaram ao aprofundamento teórico acerca da temática e a construção dos roteiros para nortear a formação profissional em saúde e educação. Resultados: Constataram-se avanços nas propostas de ações setoriais integradas das atividades, que inicialmente estimulam a implementação deste modelo aprimorando a formação dos profissionais na perspectiva da sistematização da assistência no contexto da saúde pública. Conclusão: a mobilização das pessoas e instituições foi de grande valia para a consolidação de um modelo para a formação de profissionais no setor da saúde. Introduction: This study contextualizes the creation of the Health Innovation Laboratory (LIS), established to integrate regional health and education management entities, in a state in southern Brazil. Considering that innovation in health is a functional novelty that causes transformative and durable change, producing significant results for public sector management. Objective: to report the creation of an intersectoral organization aimed at professional training in health. Methodology: Meetings were held between public and private higher education institutions and regional management bodies. The meetings aimed to deepen the theory on the topic and the construction of scripts to guide professional training in health and education. Results: Advances were noted in the proposals for integrated sectoral actions of activities, which initially stimulate the implementation of this model by improving the training of professionals from the perspective of systematizing care in the context of public health. Conclusion: the mobilization of people and institutions was of great value in consolidating a model for training professionals in the health sector. Introducción: Este estudio contextualiza la creación del Laboratorio de Innovación en Salud (LIS), creado para integrar entidades regionales de gestión de salud y educación, en un estado del sur de Brasil. Considerando que la innovación en salud es una novedad funcional que provoca cambios transformadores y duraderos, produciendo resultados significativos para la gestión del sector público. Objetivo: informar la creación de una organización intersectorial orientada a la formación profesional en salud. Metodología: Se realizaron reuniones entre instituciones de educación superior públicas y privadas y órganos de gestión regional. Los encuentros tuvieron como objetivo profundizar la comprensión teórica del tema y la construcción de guiones que orienten la formación profesional en salud y educación. Resultados: Se observaron avances en las propuestas de acciones sectoriales integradas de actividades, que inicialmente estimulan la implementación de este modelo, mejorando la formación de profesionales en la perspectiva de la sistematización de la atención en el contexto de la salud pública. Conclusión: la movilización de personas e instituciones fue de gran valor para consolidar un modelo de formación de profesionales del sector salud.

Abstract Background

Despite the benefits attributed to the use of local anesthesia (LA) for open hemorrhoidectomy (OH) in developed countries, this technique is still not considered as the first line technique in low-income countries such as Uganda; therefore, we aimed at comparing the cost of OH under LA versus Saddle block among patients with 3rd or 4th degree hemorrhoids.

Methods

This trial was conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. The operating time, and direct costs in (US$) including medical and non-medical were recorded. We analysed the cost in the two groups (local anesthesia versus saddle block) using SPSS version 23.0.

Results

Findings of fifty-eight patients were analysed including 29 participants per group. There was a significant difference in operating time and cost among the two groups (p < 0.05). The mean operating time was 15.52 ± 5.34(SD) minutes versus 33.72 ± 11.54 min for OH under LA and SB respectively. The mean cost of OH under LA was 57.42 ± 8.90 US$ compared to 63.38 ± 12.77US$ in SB group.

Conclusion

The use of local anesthesia for OH was found to have less operating time with high-cost effectiveness. Being affordable, local anesthesia can help to increase the turnover of patients who would otherwise wait for the availability of anesthesia provider. Policy makers should emphasize its applicability in low-income settings to help in the achievement of 2030 global surgery goals.

Trial registration

Pan African Clinical Trials Registry, PACTR202110667430356. Registered on 08/10/2021.

Abstract Introduction

Reduction in health inequalities and providing universal access to health care have been identified as two important global milestones by the World Health Organization for countries to achieve by 2030. Therefore, recognizing the magnitude of oral health inequalities in India has become a pressing priority to improve access to dental care within the country. This scoping review was conducted with the aim of reviewing, collating and analysing the current knowledge base on oral health inequalities in India.

Methodology

The scoping review followed Arksey and O’Malley’s approach, and reporting was performed in accordance with the PRISMA-ScR guidelines. A systematic search was conducted on Scopus, PubMed, Web of Science, and EMBASE to identify literature addressing one or more dimensions of oral health inequalities in India, published in English between January 2002 and April 2022. The data were charted, and qualitative analysis was performed to derive themes, highlighting the key concepts emerging from this review.

Results

In accordance with the eligibility criteria, a total of 71 articles retrieved through database search and backward citation search were included in this scoping review. The major themes ranged from individual to diverse sociodemographic factors acting as barriers to and facilitators of access to dental care. Deficiencies in human resources for oral health, along with a wide diversity in dental service provision and dental education were other major themes contributing to inequality. Subsequently, this has resulted in recommendations on restructuring the dental workforce and their development and modifications in oral health care policies and practices. The qualitative synthesis demonstrates the intertwined nature of the multiple factors that influence the goal of achieving an affordable, accessible, extensive and inclusive oral healthcare system in India.

Conclusions

This comprehensive review provides a broad perspective on oral health inequalities in India, providing valuable insights for both researchers and policymakers in this area and guiding their efforts towards achieving universal oral health coverage in the Indian context.

Abstract Background

Achieving the targeted organizational goals through effective training can increase employee satisfaction. Since 2015, the Supranational Reference Laboratory Uganda (SRL Uganda) has trained National Tuberculosis Reference Laboratories (NTRLs) from 21 countries in a variety of areas that cover both technical and programmatic aspects pertinent to TB laboratories. The Laboratory Quality Management System (LQMS) under SRL coordinates actions intended to ensure sustained quality of the laboratory services offered by the National TB Reference Laboratories. In order for laboratory results to be helpful in a clinical or public health setting, they must be accurate, reliable, and timely. The LQMS course aims to provide learners with knowledge on how to attain and maintain this quality. Prior to this study, there was hardly any data available on the effectiveness of LQMS trainings provided by SRL Uganda; using Kirkpatrick model, which is popular among researchers for evaluating the efficacy of the training program, this paper seeks to establish the effectiveness of the LQMS training offered by the SRL Uganda.

Method

We evaluated the effectiveness of LQMS training within the Uganda’s SRL network for courses offered during the period 2017 and 2021 for participants from the Southern and East African sub-Saharan region.

Results

In 2017 and 2021, respectively, test results from 10/17 and 9/17 showed overall post-test scores above 80%. Of the 18 labs evaluated, 14 showed improvement; of these, 7 labs were from the Eastern region and the other 7 were from Southern Africa; one facility in this region also maintained its accreditation. In the post-evaluation assessment, attendees of the LQMS course gave feedback of strongly agree and agree variety.

Conclusion

More SRL Uganda network laboratories in the regions achieved a 5-star SLIPTA level rating and among these, 5 NTRLs got ISO 15189:2012 accredited by the end of 2021, while one maintained its accreditation status. This proves that the Laboratory Quality Management System training program was an effective tool in improving the quality of laboratory services, work practices, and processes.

Abstract

This paper uses a system dynamics approach to explain how the existing socio-economic conditions in a rural region in India interact with external factors and produce feedback loops in the context of COVID-19. The Causal Loop Diagram derived using primary data, shows these linkages by examining the local health infrastructure and the lockdown as the two major external factors. Understanding their compounding effects provides insights into the antecedents of community resilience. The effects of the pandemic inspired community-led initiatives to enable people to overcome the hardships and revived community networks. Efforts by the government were directed not only towards improving the health infrastructure but also endeavored to address people’s misunderstandings about the pandemic. The study offers lessons to orient policy interventions for sustainable solutions to achieve the desired developmental goals and community well-being.

Abstract

The Nigerian health system is confronted with challenges, including but not limited to incompleteness of health data, dilapidated medical equipment, and poor healthcare financing. Thus, the Nigerian health system needs to be improved. A quality improvement intervention is a systematic continuous approach that aims to solve problems in the health system and is commonly employed to support health system development. A quality improvement intervention is more likely to work if the approach fits the targeted health system, but, there is no in-depth information on how to make a quality improvement intervention fit for the Nigerian health system. Thus, the authors consulted with health workers, key actors in the Nigerian health system regarding this. Fifty-one diverse health workers (30 health care providers & 21 health service managers) participated in this qualitative survey. The age and work experience of the participants ranged from 24 to 76 years and 1 to 50 years, respectively. Thematic analysis was performed on the data, and the main findings are reported in this abstract. The findings support that there are diverse problems across all health system building blocks. Problems in a health system building block may affect other health system building blocks. Thus, a contextually relevant quality improvement intervention in the country needs to utilize a systems thinking approach. Further, the findings suggest that collaboration, government involvement, and a data-driven approach are beneficial for developing a contextually relevant quality improvement intervention. In addition to being beneficial for developing a contextually relevant quality improvement intervention, collaboration is beneficial for implementing a contextually relevant quality improvement intervention. Finally, the findings suggest that a client-centered approach and monitoring activities are also beneficial for implementing a contextually relevant quality improvement intervention. This study provides important insights into the factors that may help the planning and implementation of a contextually relevant quality improvement intervention. Future work must investigate if the application of findings to the Nigerian context results in improved outcomes of a quality improvement intervention.

Abstract Background

Health system shocks are increasing. The COVID-19 pandemic resulted in global disruptions to health systems, including maternal and newborn healthcare seeking and provision. Yet evidence on mitigation strategies to protect newborn service delivery is limited. We sought to understand what mitigation strategies were employed to protect small and sick newborn care (SSNC) across 65 facilities Kenya, Malawi, Nigeria and Tanzania, implementing with the NEST360 Alliance, and if any could be maintained post-pandemic.

Methods

We used qualitative methods (in-depth interviews n=132, focus group discussions n=15) with purposively sampled neonatal health systems actors in Kenya, Malawi, Nigeria and Tanzania. Data were collected from September 2021 - August 2022. Topic guides were co-developed with key stakeholders and used to gain a detailed understanding of approaches to protect SSNC during the COVID-19 pandemic. Questions explored policy development, collaboration and investments, organisation of care, human resources, and technology and device innovations. Interviews were conducted by experienced qualitative researchers and data were collected until saturation was reached. Interviews were digitally recorded and transcribed verbatim. A common coding framework was developed, and data were coded via NVivo and analysed using a thematic framework approach.

Findings

We identified two pathways via which SSNC was strengthened. The first pathway, COVID-19 specific responses with secondary benefit to SSNC included: rapid policy development and adaptation, new and collaborative funding partnerships, improved oxygen systems, strengthened infection prevention and control practices. The second pathway, health system mitigation strategies during the pandemic, included: enhanced information systems, human resource adaptations, service delivery innovations, e.g., telemedicine, community engagement and more emphasis on planned preventive maintenance of devices. Chronic system weaknesses were also identified that limited the sustainability and institutionalisation of actions to protect SSNC.

Conclusion

Innovations to protect SSNC in response to the COVID-19 pandemic should be maintained to support resilience and high-quality routine SSNC delivery. In particular, allocation of resources to sustain high quality and resilient care practices and address remaining gaps for SSNC is critical.