Springer Search: "human resources for health"

Abstract Background

This study aims to describe the training offered and the availability of professionals required by the Ministry of Health for mental health problems management in the community.

Methods

A cross-sectional study was carried out on the training offered in mental health in Peruvian universities. A search for programs was conducted using the University Information System database and universities' websites, as well as using the Ministry of Health's database on health personnel and data on the number of enrolled and current students provided by the University Information System database and the Transparency section of the universities.

Results

There were 214 undergraduate, 55 specialty and 7 subspecialty programmes, of which 39%, 47% and 100%, respectively, were offered in the capital city. The duration ranged from 5 to 7 years for undergraduate programs and from 1 to 3 years for subspecialty and second specialty programs. The cost of undergraduate programs ranged from free of charge up to USD 6863.75 for the first semester of study. Second specialty programs ranged from 720 up to 11 986 USD and subspecialty programs ranged from 2267 up to 9138 USD, with medicine being the most expensive. On the other hand, there are a greater number of psychology students (n = 78 781) pursuing undergraduate studies than working professionals (n = 5368), while in the second specialty of psychiatry there are far fewer students pursuing the specialty (n = 67) than working professionals (n = 454).

Conclusions

The problem of professional training in mental health requires that the institutions involved in health and education develop policies to decentralize programs, communicate the demand for professionals in certain areas, make them accessible to the low-income population, respond to mental health problems and guarantee their quality. On the other hand, regarding the low number of mental health personnel working, it is suggested to increase the mental health budget to generate more mental health services and employment.

Abstract Background

Mother–infant care (MIC) helpers have become an indispensable part in hospital services. In order to stabilize the MIC workforce, it is essential for administrators to have a solid understanding of what may influence occupational wellbeing. This article aims to explore how demographic characteristics and psychological contract affect occupational wellbeing among MIC helpers in Zhejiang Province, China.

Methods

This is a quantitative, cross-sectional study with MIC helpers in obstetrics from 20 hospitals in Zhejiang Province. A questionnaire including demographic data, a psychological contract scale and an occupational wellbeing scale was used in this study. Multiple linear regression was conducted to investigate the relationships between demographic characteristics, psychological contract and occupational wellbeing.

Results

This study surveyed 260 MIC helpers and found out the mean score of the psychological contract was 4.38 and the mean score of the occupational wellbeing was 4.01. Monthly income and psychological contract were significant predictors of occupational wellbeing (F = 142.167, p < 0.001), which explained 62.1% of the total amount of variance in occupational wellbeing. Psychological contract was the most important predictor of occupational wellbeing.

Conclusions

Administrators should pay attention to the effect of psychological contract on occupational wellbeing of the MIC helpers in China. Focusing on the inner needs should be considered as a strategy for stabilizing the team.

Abstract Background

The Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, was implemented in the Western Highlands of the Department of Huehuetenango, Guatemala. The Project utilized three participatory approaches in tandem: the Census-Based, Impact-Oriented (CBIO) Approach, the Care Group Approach, and the Community Birthing Center Approach. Together, these are referred to as the Expanded CBIO Approach (or CBIO+).

Objective

This is the first article of a supplement that assesses the effectiveness of the Project’s community-based service delivery platform that was integrated into the Guatemalan government’s rural health care system and its special program for mothers and children called PEC (Programa de Extensión de Cobertura, or Extension of Coverage Program).

Methods

We review and summarize the CBIO+ Approach and its development. We also describe the Project Area, the structure and implementation of the Project, and its context.

Results

The CBIO+ Approach is the product of four decades of field work. The Project reached a population of 98,000 people, covering the entire municipalities of San Sebastián Coatán, Santa Eulalia, and San Miguel Acatán. After mapping all households in each community and registering all household members, the Project established 184 Care Groups, which were composed of 5–12 Care Group Volunteers who were each responsible for 10–15 households. Paid Care Group Promoters provided training in behavior change communication every two weeks to the Care Groups. Care Group Volunteers in turn passed this communication to the mothers in their assigned households and also reported back to the Care Group Promoters information about any births or deaths that they learned of during the previous two weeks as a result of their regular contact with their neighbors. At the outset of the Project, there was one Birthing Center in the Project Area, serving a small group of communities nearby. Two additional Birthing Centers began functioning as the Project was operating. The Birthing Centers encouraged the participation of traditional midwives (called comadronas) in the Project Area.

Conclusion

This article serves as an introduction to an assessment of the CBIO+ community-based, participatory approach as it was implemented by Curamericas/Guatemala in the Western Highlands of the Department of Huehuetenango, Guatemala. This article is the first of a series of articles in a supplement entitled Reducing Inequities in Maternal and Child Health in Rural Guatemala through the CBIO+ Approach of Curamericas.

Abstract Background

This systematic review and meta-analysis identified early evidence quantifying the disruption to the education of health workers by the COVID-19 pandemic, ensuing policy responses and their outcomes.

Methods

Following a pre-registered protocol and PRISMA/AMSTAR-2 guidelines, we systematically screened MEDLINE, EMBASE, Web of Science, CENTRAL, clinicaltrials.gov and Google Scholar from January 2020 to July 2022. We pooled proportion estimates via random-effects meta-analyses and explored subgroup differences by gender, occupational group, training stage, WHO regions/continents, and study end-year. We assessed risk of bias (Newcastle–Ottawa scale for observational studies, RοB2 for randomized controlled trials [RCT]) and rated evidence certainty using GRADE.

Results

Of the 171 489 publications screened, 2 249 were eligible, incorporating 2 212 observational studies and 37 RCTs, representing feedback from 1 109 818 learners and 22 204 faculty. The sample mostly consisted of undergraduates, medical doctors, and studies from institutions in Asia. Perceived training disruption was estimated at 71.1% (95% confidence interval 67.9–74.2) and learner redeployment at 29.2% (25.3–33.2). About one in three learners screened positive for anxiety (32.3%, 28.5–36.2), depression (32.0%, 27.9–36.2), burnout (38.8%, 33.4–44.3) or insomnia (30.9%, 20.8–41.9). Policy responses included shifting to online learning, innovations in assessment, COVID-19-specific courses, volunteerism, and measures for learner safety. For outcomes of policy responses, most of the literature related to perceptions and preferences. More than two-thirds of learners (75.9%, 74.2–77.7) were satisfied with online learning (postgraduates more than undergraduates), while faculty satisfaction rate was slightly lower (71.8%, 66.7–76.7). Learners preferred an in-person component: blended learning 56.0% (51.2–60.7), face-to-face 48.8% (45.4–52.1), and online-only 32.0% (29.3–34.8). They supported continuation of the virtual format as part of a blended system (68.1%, 64.6–71.5). Subgroup differences provided valuable insights despite not resolving the considerable heterogeneity. All outcomes were assessed as very-low-certainty evidence.

Conclusion

The COVID-19 pandemic has severely disrupted health worker education, inflicting a substantial mental health burden on learners. Its impacts on career choices, volunteerism, pedagogical approaches and mental health of learners have implications for educational design, measures to protect and support learners, faculty and health workers, and workforce planning. Online learning may achieve learner satisfaction as part of a short-term solution or integrated into a blended model in the post-pandemic future.

Abstract Background

Health practitioner regulators throughout the world use registration standards to define the requirements health practitioners need to meet for registration. These standards commonly include recency of practice (ROP) standards designed to ensure that registrants have sufficient recent practice in the scope in which they intend to work to practise safely. As the ROP registration standards for most National Boards are currently under review, it is timely that an appraisal of current evidence be carried out.

Methods

A systematic review was conducted using databases (including MEDLINE, EMBASE, PsycInfo, and CINAHL), search engines, and a review of grey literature published between 2015 and April 2022. Publications included in the review were assessed against the relevant CASP checklist for quantitative studies and the Joanna Briggs Institute checklist for analytical cross-sectional studies.

Results

The search yielded 65 abstracts of which 12 full-text articles met the inclusion criteria. Factors that appear to influence skills retention include the length of time away from practice, level of previous professional experience and age, as well as the complexity of the intervention. The review was unable to find a clear consensus on the period of elapsed time after which a competency assessment should be completed.

Conclusions

Factors that need to be taken into consideration in developing ROP standards include length of time away from practice, previous experience, age and the complexity of the intervention, however, there is a need for further research in this area.

Abstract Background

A recent world health report suggests that there is a growing rehabilitation human resource crisis. This review focuses on the capacity-building needed to meet present and future rehabilitation challenges in low- and middle-income countries (LMICs). Capacity-building is the process by which individuals and organizations obtain, improve, and retain the skills, knowledge, tools, equipment, and other resources needed to do their jobs competently. The objectives of this review are (1) to determine how capacity-building has been defined, implemented, and evaluated in LMICs and (2) to provide an overview of the effectiveness of capacity-building initiatives.

Methods

In the first of seven stages, we will refine and delimit the research. Then, we will identify relevant studies by searching five biomedical databases, two rehabilitation databases, three regional databases, and three databases of gray literature. Two independent reviewers will then select the studies using a priori selection criteria. We will exclude incomplete records, records published prior to 2000 for databases and 2010 for gray literature, and records written in languages other than English or Spanish. We will also exclude records focusing on entry-to-practice programs in academic settings. For Objective 1, using qualitative analysis software, we will extract and analyze text from included records that define or explains capacity building. For Objective 2, using an online file-sharing platform, one reviewer will extract data describing the effectiveness of capacity-building interventions and a second reviewer will verify the accuracy, with disagreements resolved by consensus. The results will be collated using tables and charts. After synthesizing the results, we will discuss the practicality and applicability of the findings with partners from Honduras and Colombia. We will use several formats and venues including presentations and publications in English and Spanish to present our results.

Discussion

To our knowledge, this will be the first attempt to systematically identify knowledge of capacity-building and rehabilitation in LMICs. This scoping review results will offer unique insights concerning the breadth and depth of literature in the area. It is anticipated that results from this scoping review will guide efforts in future capacity-building efforts in rehabilitation in LMICs.

Review registration

Busch AJ, Deprez D, Bidonde J, Ramírez PA, Araque EP. Capacity building and continuing professional development in healthcare and rehabilitation in low- and middle-income countries—a scoping review. 2021. https://doi.org/10.17605/OSF.IO/7VGXU.

Abstract Aims and objectives

To examine factors associated with promotion of the nursing profession, to the nursing community, other healthcare professionals and the general public, by nurses employed in diverse healthcare settings.

Background

Little is known about the factors that contribute to nurses’ involvement in the promotion of the nursing profession.

Methods

This cross-sectional study comprises a convenience sample of registered nurses (n = 526) with ≥ 3 months’ experience in nursing, who are employed in internal and surgical units, pediatric wards, psychiatric wards or in the community across Israel. Participants completed a self-administered questionnaire addressing socio-demographic, occupational and organizational factors relating to the nursing work environment and to the extent of nurses’ involvement in promotion of the nursing profession. Descriptive statistics, one-way analysis of variance, Pearson’s correlation analysis, and multivariate linear regression were performed.

Results

Nurses in all the surveyed healthcare settings reported relatively low levels of involvement in promotion of the profession, either to the nursing community or to other healthcare professionals and the public. Being a female-nurse was significantly negatively associated with nurses’ involvement in promotion of the nursing profession. In contrast, holding a master’s degree in nursing, having a managerial role, and working in a supportive organizational nursing work environment were the principal factors associated with positive promotion of the nursing profession.

Conclusion

The extent of nurses’ involvement in promotion of the nursing profession mainly depends on occupational factors and a supportive organizational nursing work environment.

Clinical relevance

Healthcare managers may advance nurses’ involvement in promotion of the profession by modifying the organizational nursing work environment. Specifically, we recommend nurse leaders to dedicate efforts to make professional promotion an integral part of a nurse’s role.

Abstract Introduction

Organizational commitment refers to the extent to which employees identify with and are involved with a given organization. It is an important variable for healthcare organizations to consider since it acts as a predictor of job satisfaction, organizational efficiency and effectiveness, health professionals’ absenteeism, and turnover. However, there is a knowledge gap in the health sector about workplace factors that are associated with healthcare provider commitment to their organization. Thus, this study aimed to assess organizational commitment and associated factors among health professionals working in public hospitals in the southwestern Oromia region, Ethiopia.

Methods

A facility-based analytical cross-sectional study was conducted from March 30 to April 30, 2021. A multistage sampling technique was employed to select 545 health professionals from public health facilities. Data were collected using a structured self-administered questionnaire. simple and multiple linear regression analyses were employed to assess the association between organizational commitment and explanatory variables after checking the assumptions of factor analysis and linear regression. The statistical significance was declared at a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI).

Results

Health professionals’ organizational commitment percentage mean score was 48.8% (95% CI: 47.39, 50.24). A higher level of organizational commitment was associated to satisfaction with recognition, work climate, supervisor support, and workload. Besides, good practice of transformational and transactional leadership styles and employee empowerment are significantly associated with high organizational commitment.

Conclusion

The overall level of organizational commitment is a bit low. To improve the organizational commitment of health professionals, hospital managers, and healthcare policy-makers need to develop and institutionalize evidence-based satisfaction strategies, practice good leadership styles and empower healthcare providers on the job.

Abstract Background

Zambia experienced a major decline in under-five mortality rates (U5MR), with one of the fastest declines in socio-economic disparities in sub-Saharan Africa in the last two decades. We aimed to understand the extent to which, and how, Zambia has reduced socio-economic inequalities in U5MR since 2000.

Methods

Using nationally-representative data from Zambia Demographic Health Surveys (2001/2, 2007, 2013/14 and 2018), we examined trends and levels of inequalities in under-five mortality, intervention coverage, household water and sanitation, and fertility. This analysis was integrated with an in-depth review of key policy and program documents relevant to improving child survival in Zambia between 1990 and 2020.

Results

The under-five mortality rate (U5MR) declined from 168 to 64 deaths per 1000 live births between 2001/2 and 2018 ZDHS rounds, particularly in the post-neonatal period. There were major reductions in U5MR inequalities between wealth, education and urban–rural residence groups. Yet reduced gaps between wealth groups in estimated absolute income or education levels did not simultaneously occur. Inequalities reduced markedly for coverage of reproductive, maternal, newborn and child health (RMNCH), malaria and human immunodeficiency virus interventions, but less so for water or sanitation and fertility levels.

Several policy and health systems drivers were identified for reducing RMNCH inequalities: policy commitment to equity in RMNCH; financing with a focus on disadvantaged groups; multisectoral partnerships and horizontal programming; expansion of infrastructure and human resources for health; and involvement of community stakeholders and service providers.

Conclusion

Zambia’s major progress in reducing inequalities in child survival between the poorest and richest people appeared to be notably driven by government policies and programs that centrally valued equity, despite ongoing gaps in absolute income and education levels. Future work should focus on sustaining these gains, while targeting families that have been left behind to achieve the sustainable development goal targets.

Abstract Background

Much has been written about the state and persistent lack of progress regarding gender equity and the commonly referenced phenomenon of a ‘leaking pipeline’. This framing focuses attention on the symptom of women leaving the workforce, rather than the well-documented contributing factors of hindered recognition, advancement, and financial opportunities. While attention shifts to identifying strategies and practices to address gender inequities, there is limited insight into the professional experiences of Canadian women, specifically in the female-dominated healthcare sector.

Methods

We conducted a survey of 420 women working across a range of roles within healthcare. Frequencies and descriptive statistics were calculated for each measure as appropriate. For each respondent, two composite Unconscious Bias (UCB) scores were created using a meaningful grouping approach.

Results

Our survey results highlight three key areas of focus to move from knowledge to action, including (1) identifying the resources, structural factors, and professional network elements that will enable a collective shift towards gender equity; (2) providing women with access to formal and informal opportunities to develop the strategic relational skills required for advancement; and (3) restructuring social environments to be more inclusive. Specifically, women identified that self-advocacy, confidence building, and negotiation skills were most important to support development and leadership advancement.

Conclusions

These insights provide systems and organizations with practical actions they can take to support women in the health workforce amid a time of considerable workforce pressure.

Abstract Introduction

The reorganization of healthcare systems to face the COVID-19 pandemic has led to concerns regarding psychological distress of healthcare workers, and training requirements of physician residents.

Objective

To assess the influence of COVID-19 pandemic on depression, anxiety, burnout and training schedules of residents.

Methods

Two independent cross-sectional studies (the first in November 2019 [control], the second in June 2020, during the first wave of COVID-19 pandemic) enrolling physician residents from Brazil, using online surveys. In each of them, we collected demographic and training program data, and assessed depression, anxiety and burnout through PHQ-2, GAD-2 and MBI (2-item version) scales, respectively. We controlled confounding variables with logistic regression analysis.

Results

The COVID-19 cohort (n = 524) presented a briefer workload and had at least 1 day off per week more frequently, in relation to the control cohort (n = 1 419). The majority of residents (464/524, 89.5%) had a reduction in their duty hours, and believed they would need an extra training period after the end of the pandemic (399/524, 76.2%). The frequency of depression increased (46.0% vs. 58.8%, aOR = 1.64, 95% CI = 1.32–2.05), anxiety did not change (56.5% vs. 56.5%, aOR = 1.24, 95% CI = 0.99–1.55) and burnout decreased (37.0% vs. 26.1%, aOR = 0.77, 95% CI = 0.60–0.99). Sensitivity analysis did not change these results.

Conclusion

Mental distress is frequent among residents and associated with both training program and social environments. The consequences of the COVID-19 pandemic on training requirements should be specifically addressed by supervisors and policymakers, in a case-by-case basis. Psychological support must be provided to healthcare workers.

Abstract Background

Many high-income countries are heavily dependent on internationally trained doctors to staff their healthcare workforce. Over one-third of doctors practising in the UK received their primary medical qualification abroad. Simultaneously, an average of around 2.1% of doctors leave the UK medical workforce annually to go overseas. The aim of this study was to identify the drivers and barriers of international migration of doctors to and from the UK.

Methods

A scoping review was conducted. We searched EMBASE, MEDLINE, CINAHL, ERIC and BEI in January 2020 (updated October 2021). Grey literature and citation searching were also carried out. Empirical studies reporting on the drivers and barriers to the international migration of doctors to and from the UK published in the English language from 2009 to present were included. The drivers and barriers were coded in NVivo 12 building on an existing framework.

Results

40 studies were included. 62% were quantitative, 18% were qualitative, 15% were mixed-methods and 5% were literature reviews. Migration into and out of the UK is determined by a variety of macro- (global and national factors), meso- (profession led factors) and micro-level (personal factors). Interestingly, many of the key drivers of migration to the UK were also factors driving migration from the UK, including: poor working conditions, employment opportunities, better training and development opportunities, better quality of life, desire for a life change and financial reasons. The barriers included stricter immigration policies, the registration process and short-term job contracts.

Conclusions

Our research contributes to the literature by providing a comprehensive up-to-date review of the drivers and barriers of migration to and from the UK. The decision for a doctor to migrate is multi-layered and is a complex balance between push/pull at macro-/meso-/micro-levels. To sustain the UK’s supply of overseas doctors, it is vital that migration policies take account of the drivers of migration particularly working conditions and active recruitment while addressing any potential barriers. Immigration policies to address the impact of Brexit and the COVID-19 pandemic on the migration of doctors to and from the UK will be particularly important in the immediate future.

Trial registration PROSPERO CRD42020165748.

Abstract

Makerere University College of Health Sciences, Kampala, Uganda, has established partnerships with several other institutions worldwide, including the University of Brescia and “Magna Græcia” University, which have agreed to collaborate for the primary purpose of student exchange. Our aim is to comment on students’ preparation for away rotations based on the authors’ own experiences and opinions alongside a review of selected papers on the preparation of students for global health and ethical collaboration. Medical electives represent a unique opportunity for all medical students, not merely for those who will work in resource-limited settings due to increasing globalization. The emergence of ethical international collaborations is of paramount importance to stimulate these projects and ensure that they are implemented safely and with adequate preparation even and especially during the COVID-19 pandemic.

Abstract Background

The increased need for mental health and substance use health (MHSUH) services during the COVID-19 pandemic underscores the need to better understand workforce capacity. This study aimed to examine the pandemic’s impact on the capacity of MHSUH service providers and to understand reasons contributing to changes in availability or ability to provide services.

Methods

We conducted a mixed method study including a pan-Canadian survey of 2177 providers of MHSUH services and semi-structured interviews with 13 key informants. Survey participants answered questions about how the pandemic had changed their capacity to provide services, reasons for changes in capacity, and how their practice had during the pandemic. Thematic analysis of key informant interviews was conducted to gain a deeper understanding of the impact of the pandemic on the MHSUH workforce.

Results

Analyses of the survey data indicated that the pandemic has had diverse effects on the capacity of MHSUH workers to provide services: 43% indicated decreased, 24% indicated no change, and 33% indicated increased capacity. Logistic regression analyses showed that privately funded participants had 3.2 times greater odds of increased capacity (B = 1.17, p < 0.001), and participants receiving funding from a mix of public and private sources had 2.4 times greater odds of increased capacity (B = 0.88, p < 0.001) compared to publicly funded participants. Top reasons for decreases included lockdown measures and clients lacking access or comfort with virtual care. Top reasons for increases included using virtual care and more people having problems relevant to the participant's skills. Three themes were constructed from thematic analysis of key informant interviews: the differential impact of public health measures, long-term effects of pandemic work conditions, and critical gaps in MHSUH workforce data.

Conclusions

The COVID-19 pandemic has had a substantial impact on the capacity of the MHSUH workforce to provide services. Findings indicate the importance of increasing and harmonizing funding for MHSUH services across the public and private sectors, developing standardized datasets describing the MHSUH workforce, and prioritizing equity across the spectrum of MHSUH services.

Abstract Background

Workplace violence (WPV) is considered a global problem, particularly in the health sector; however, no studies have assessed the national prevalence of WPV against emergency physicians and the associated factors in China.

Methods

A national cross-sectional survey was conducted in 31 provinces/autonomous regions/municipalities across China between July 2019 and September 2019. A total of 15 455 emergency physicians were selected using a multistage stratified random sampling method. A structured self-administered questionnaire was used to collect information on WPV and potential associated factors among emergency physicians. Descriptive and multivariable logistic regression analyses were used to identify the predictors of WPV.

Results

A total of 14 848 emergency physicians responded effectively (effective response rate: 96.07%). Of the respondents, 90.40%, 51.45%, and 90.00% reported exposure to any type of WPV, physical or nonphysical violence in the preceding year, respectively. Verbal aggression (87.25%) was the most common form of violence, followed by threat (71.09%), physical assault (48.24%), verbal sexual harassment (38.13%), and sexual assault (19.37%). Patients’ families were the main perpetrators of these incidents. Unmet patient needs, taking drugs or drinking, and long waiting times were the main contributors to WPV. Physicians who were from low-developed regions, female, and without shift work were less likely to have experienced any type of WPV. Chinese emergency physicians who were from medium-developed regions, had a bachelor’s degree, worked in a higher level hospital, had a higher professional title, with lower incomes, had a history of hypertension or coronary heart disease, were smokers or drinkers, and worked in hospitals without preventive measures or training for WPV and not encouraging to report WPV were more likely to have experienced any type of WPV. The predictors of WPV varied in different types of WPV.

Conclusions

This study shows that the prevalence of WPV against emergency physicians is high in China. Measures should be taken at the physicians, patients, hospital, and national levels to protect GPs from WPV; for example, improving physicians’ level of service and hospital’ reporting procedures. Creating a prevention strategy and providing a safer workplace environment for emergency physicians should be prioritized.

Abstract Background

Expanding the health workforce to increase the availability of skilled birth attendants (SBAs) presents an opportunity to expand the power and well-being of frontline health workers. The role of the SBA holds enormous potential to transform the relationship between women, birthing caregivers, and the broader health care delivery system. This paper will present a novel approach to the community-based skilled birth attendant (SBA) role, the Skilled Health Entrepreneur (SHE) program implemented in rural Sylhet District, Bangladesh.

Case presentation

The SHE model developed a public–private approach to developing and supporting a cadre of SBAs. The program focused on economic empowerment, skills building, and formal linkage to the health system for self-employed SBAs among women residents. The SHEs comprise a cadre of frontline health workers in remote, underserved areas with a stable strategy to earn adequate income and are likely to remain in practice in the area. The program design included capacity-building for the SHEs covering traditional techno-managerial training and supervision in programmatic skills and for developing their entrepreneurial skills, professional confidence, and individual decision-making. The program supported women from the community who were social peers of their clients and long-term residents of the community in becoming recognized, respected health workers linked to the public system and securing their livelihood while improving quality and access to maternal health services. This paper will describe the SHE program's design elements to enhance SHE empowerment in the context of discourse on social power and FLHWs.

Conclusion

The SHE model successfully established a private SBA cadre that improved birth outcomes and enhanced their social power and technical skills in challenging settings through the mainstream health system. Strengthening the agency, voice, and well-being of the SHEs has transformative potential. Designing SBA interventions that increase their power in their social context could expand their economic independence and reinforce positive gender and power norms in the community, addressing long-standing issues of poor remuneration, overburdened workloads, and poor retention. Witnessing the introduction of peer or near-peer women with well-respected, well-compensated roles among their neighbors can significantly expand the effectiveness of frontline health workers and offer a model for other women in their own lives.

Abstract Background

Inequities in health access and outcomes persist in low- and middle-income countries. While strengthening primary care is integral in improving patient outcomes, primary care networks remain undervalued, underfunded, and underdeveloped in many LMICs such as the Philippines. This paper underscores the value of strengthening primary care system interventions in LMICs by examining their impact on job satisfaction and intention to stay among healthcare workers in the Philippines.

Methods

This study was conducted in urban, rural, and remote settings in the Philippines. A total of 36 urban, 54 rural, and 117 remote healthcare workers participated in the study. Respondents comprised all family physicians, nurses, midwives, community health workers, and staff involved in the delivery of primary care services from the sites. A questionnaire examining job satisfaction (motivators) and dissatisfaction (hygiene) factors was distributed to healthcare workers before and after system interventions were introduced across sites. Interventions included the introduction of performance-based incentives, the adoption of electronic health records, and the enhancement of diagnostic and pharmaceutical capabilities over a 1-year period. A Wilcoxon signed-rank test and a McNemar’s chi-square test were then conducted to compare pre- and post-intervention experiences for each setting.

Results

Among the factors examined, results revealed a significant improvement in perceived compensation fairness among urban (p = 0.001) and rural (p = 0.016) providers. The rural workforce also reported a significant improvement in medicine access (p = 0.012) post-intervention. Job motivation and turnover intention were sustained in urban and rural settings between periods. Despite the interventions introduced, a decline in perceptions towards supply accessibility, job security, and most items classified as job motivators was reported among remote providers. Paralleling this decline, remote primary care providers with the intent to stay dropped from 93% at baseline to 75% at endline (p < 0.001).

Conclusion

The impact of strengthening primary care on health workforce satisfaction and turnover intention varied across urban, rural, and remote settings. While select interventions such as improving compensation were promising for better-supported settings, the immediate impact of these interventions was inadequate in offsetting the infrastructural and staffing gaps experienced in disadvantaged areas. Unless these problems are comprehensively addressed, satisfaction will remain low, workforce attrition will persist as a problem, and marginalized communities will be underserved.

Abstract Background

Healthcare workers’ (HCWs) knowledge of multi-stranded cholera interventions (including case management, water, sanitation, and hygiene (WASH), surveillance/laboratory methods, coordination, and vaccination) is crucial to the implementation of these interventions in healthcare facilities, especially in conflict-affected settings where cholera burden is particularly high. We aimed to assess Nigerian HCWs’ knowledge of cholera interventions and identify the associated factors.

Methods

We conducted a cross-sectional study using a structured interviewer-administered questionnaire with HCWs from 120 healthcare facilities in Adamawa and Bauchi States, North-East Nigeria. A knowledge score was created by assigning a point for each correct response. HCWs’ knowledge of cholera interventions, calculated as a score, was recoded for ease of interpretation as follows: 0–50 (low); 51–70 (moderate); ≥ 71 (high). Additionally, we defined the inadequacy of HCWs’ knowledge of cholera interventions based on a policy-relevant threshold of equal or lesser than 75 scores for an intervention. Multivariable logistic regression was used to identify the factors associated with the adequacy of knowledge score.

Results

Overall, 490 HCWs participated in the study (254 in Adamawa and 236 in Bauchi), with a mean age of 35.5 years. HCWs’ knowledge score was high for surveillance/laboratory methods, moderate for case management, WASH, and vaccination, and low for coordination. HCWs’ knowledge of coordination improved with higher cadre, working in urban- or peri-urban-based healthcare facilities, and secondary education; cholera case management and vaccination knowledge improved with post-secondary education, working in Bauchi State and urban areas, previous training in cholera case management and response to a cholera outbreak—working in peri-urban areas had a negative effect. HCWs’ knowledge of surveillance/laboratory methods improved with a higher cadre, 1-year duration in current position, secondary or post-secondary education, previous training in cholera case management and response to a cholera outbreak. However, HCWs’ current position had both positive and negative impacts on their WASH knowledge.

Conclusions

HCWs in both study locations recorded a considerable knowledge of multi-stranded cholera interventions. While HCWs’ demographic characteristics appeared irrelevant in determining their knowledge of cholera interventions, geographic location and experiences from the current position, training and involvement in cholera outbreak response played a significant role.

Abstract Background

Abortion-related complications contribute to preventable maternal mortality, accounting for 9.8% of maternal deaths globally, and 15.6% in sub-Saharan Africa. High-quality postabortion care (PAC) can mitigate the negative health outcomes associated with unsafe abortion. While the expanded Global Gag Rule policy did not prohibit the provision of PAC, other research has suggested that over-implementation of the policy has resulted in impacts on these services. The purpose of this study was to assess health facilities’ capacity to provide PAC services in Uganda and PAC and safe abortion care (SAC) in Ethiopia during the time in which the policy was in effect.

Methods

We collected abortion care data between 2018 and 2020 from public health facilities in Ethiopia (N = 282) and Uganda (N = 223). We adapted a signal functions approach to create composite indicators of health facilities’ capacity to provide basic and comprehensive PAC and SAC and present descriptive statistics documenting the state of service provision both before and after the GGR went into effect. We also investigate trends in caseloads over the time-period.

Results

In both countries, service coverage was high and improved over time, but facilities’ capacity to provide basic PAC services was low in Uganda (17.8% in 2019) and Ethiopia (15.0% in 2020). The number of PAC cases increased by 15.5% over time in Uganda and decreased by 7% in Ethiopia. Basic SAC capacity increased substantially in Ethiopia from 66.7 to 82.8% overall, due in part to an increase in the provision of medication abortion, and the number of safe abortions increased in Ethiopia by 9.7%.

Conclusions

The findings from this analysis suggest that public health systems in both Ethiopia and Uganda were able to maintain essential PAC/SAC services during the GGR period. In Ethiopia, there were improvements in the availability of safe abortion services and an overall improvement in the safety of abortion during this time-period. Despite loss of partnerships and potential disruptions in referral chains, lower-level facilities were able to expand their capacity to provide PAC services. However, PAC caseloads increased in Uganda which could indicate that, as hypothesized, abortion became more stigmatized, less accessible and less safe.

Abstract Background

Methylphenidate (MPH) and other stimulants may be misused, mainly as cognitive enhancers and recreational drugs. Data regarding misuse among medical residents are scarce. This study aimed to evaluate the prevalence of and main reasons for methylphenidate (MPH) use and misuse among Israeli medical residents.

Methods

In this cross-sectional study, we sent an online questionnaire to medical residents who had completed their first residency exam and specialists with up to 2 years of experience. We asked about the use of MPH before and during residency and attitudes toward the use of MPH as a cognitive enhancer. We also added the Adult ADHD Self-Report Scale (ASRS) questionnaire, a validated tool used to screen for the presence of attention deficit hyperactivity disorder (ADHD). Users and misusers were classified based on self-report of use and formal ADHD diagnosis. Logistic regression analysis was used to evaluate factors associated with MPH misuse.

Results

From March 2021 to August 2021, 370 physicians responded to our questionnaire (response rate 26.4%). Twenty-eight met the exclusion criteria and were not included. The respondents’ average age was 36.5 years. Women comprised 63.5% of the respondents. Of the participants, 16.4% were classified as users and 35.1% as misusers. The prevalence of misusers was 45.6% among surgery and OB/GYN physicians, 39.4% among pediatricians and internists, and 24% among family physicians (P < 0.001). Misusers had a more liberal approach than others to MPH use as a cognitive enhancer. Factors associated with misuse of MPH included not being a native-born Israeli (OR-1.99, 95% CI 1.08, 3.67) and type of residency (OR-2.33, 95% CI 1.22, 4.44 and OR-4.08, 95% CI 2.06, 8.07 for pediatrics and internal medicine and surgery, respectively).

Conclusion

Very high levels of MPH misuse during residency may be related to stress, long working hours, night shifts, and the academic burden of the residency period. We believe that our findings should be considered by healthcare policymakers as they make decisions regarding the conditions of medical residencies. The use of MPH as a cognitive enhancer should be further studied and discussed.