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A comprehensive, accurate description of workforce capacity is important for health service planning, to ensure that health services meet local needs. In many low- to middle-income countries, the government’s service planning ability is barred by the lack of accurate and/or comprehensively-described workforce data. In these low-resource settings, lack of appropriate planning leads to limited or no access to rehabilitation services. Variability in the definitions and scope of rehabilitation professionals further complicates the understanding of rehabilitation services and how it should be planned and delivered. Another challenge to describing the primary rehabilitation workforce capacity, is the lack of standardised and agreed-upon global metrics. These inconsistencies highlight the need for a comprehensive understanding of current practices, which can offer guidance to countries wishing to describe their rehabilitation workforce. This study aimed to scope the range of descriptors and metrics used to describe the rehabilitation workforce and to compare the workforce across countries that used similar descriptors in published reports.Methods
A scoping review was conducted according to the five-step framework first developed by Arksey and O’Malley. The review included a broad search of literature regarding the rehabilitation workforce and how countries quantify and describe the rehabilitation workforce.Results
Nineteen studies on rehabilitation workforce capacity were identified. All but one (a cross-sectional study) were database reviews. The main descriptors and indicators used to describe the rehabilitation workforce capacity were profession type, age, gender, distributions between urban/rural, level of care, and private/public sectors, absolute count totals, and population-adjusted ratios.Conclusion
This scoping review provided an overview of descriptors and indicators used to describe the rehabilitation workforce capacity internationally. The study is a first step towards developing standardised descriptors and metrics to quantify the rehabilitation workforce capacity, that will allow for comparison between different settings.Trial registration
This scoping review protocol has been registered with the Open Science Framework (http://osf.10/7h6xz).
A Novel Interprofessional Education and Supervision Student Placement Model: Student and Clinical Educator Perspectives and Experiences.
Components of interprofessional education programs in neonatal medicine: A focused BEME review: BEME Guide No. 73.
The Development and Validation of a Professional Development Program for Health Professional Educators in Ethiopian Higher Education Context
Despite the presence of a common agreement on the importance of integrating professional development (PD) for instructors in higher education (HE), the level of progress made in that regard varies greatly across HE systems around the world. Part of the variation was due to the lack of comprehensive theories and guidelines that leverage efforts to integrate PD issues into HE system. Also, there is limited research regarding the development and revision of PD programs for instructors of health sciences in HE setting. The limited studies primarily lack a comprehensive or all-encompassing framework that capture the complexities of the program development and validation process. Rather, they are essentially impact evaluation studies, examining the short-term and long-term benefits of the programs under studies. This study offers a theoretical rationale and a three-step framework for PD program development and review in HE through presenting a case study of an innovative PD program in the Ethiopian public university context. A three-step approach that consists of curriculum development, an iterative research–based review, and collaborative revision and validation is recommended in this study, to promote a commitment to systematic planning and research-based review and revision in a PD of instructors in HE in Ethiopia and beyond.
The roles of physician associates and advanced nurse practitioners in the National Health Service in the UK: a scoping review and narrative synthesis
Mid-level practitioners (MLPs), including physician associates (PAs) and advanced nurse practitioners (ANPs), have emerged to address workforce shortages in the UK and perform specific roles in relation to population needs. This has resulted in new ways of working and changes to established professional hierarchies. We conducted a study to investigate the career development, competencies, effectiveness, perceptions, and regulation of PAs and ANPs, with the aim of understanding ways to effectively integrate MLPs into the NHS workforce.Methods
We conducted a systematic scoping review following PRISMA guidelines. Embase, Medline, the Cochrane database, Pubmed, and CINAHL databases were searched, using terms relating to PAs and ANPs in the UK. A total of 128 studies (60 on PAs and 68 on ANPs) were included in the final analysis. A narrative synthesis, guided by the pre-defined themes and emerging themes, was conducted to bring together the findings.Results
PAs are educated on a medical model with basic medical skills but lack formal professional regulation and do not have prescribing rights. ANPs are educated on a nurse model with enhanced skills that depend on roles within specific specialities, and their governance is mostly employer-led. PAs are primarily employed in secondary care. ANPs are employed widely in both primary and secondary care. No defined career progression exists for PAs. In contrast, becoming an ANP is a form of career progression within nursing. Both roles were regarded as cost-effective in comparison to doctors performing simple tasks. PAs were less understood compared to ANPs and received a mixed reception from colleagues, which sometimes undermined their professional identity, whereas ANPs were mostly welcomed by colleagues.Conclusions
Potential ways to better integrate PAs and ANPs into the NHS workforce include further initiatives by regulatory bodies and the NHS to create more awareness and clearer role definitions for MLPs, outline potential for career progression, offer transparency with regard to remuneration, and introduction of prescribing rights. Future research might include more cadres of MLPs and explore the international literature.
Delivery of interprofessional education through a co-curricular journal reviewing medical literature.
Incorporation of Child & Adolescent Mental Health Standardized Patient Simulations to Provide Interprofessional Education for Graduate Students.
Interdisciplinary interprofessional education using an online learning environment called values exchange: A qualitative investigation.
A qualitative exploration of Ugandan mental health care workers’ perspectives and experiences on sexual and reproductive health of people living with mental illness in Uganda
People with Mental Illness experience vast sexual and reproductive health challenges due to the affected mental health. Globally, prevalence of mental illness is on the rise with subsequent increase in the number of people with sexual and reproductive challenges warranting urgent public health intervention. However, information on the perceptions and experiences of mental health workers, the key health care providers for this population is generally lacking yet it’s essential for formulation of appropriate policies and public health interventions.Aim
To explore Ugandan mental health care worker’s perspectives and experiences on the sexual and reproductive health of people living with mental illness in Uganda in order to generate recommendations to the ministry of health on how it can be improved.Materials and methods
Qualitative study design was employed with utilization of phone call semi-structured in-depth interviews to collect data from 14 mental health workers from Uganda’s National mental referral hospital, Butabika. Purposive sampling and convenience recruitment was done and the collected data was analyzed using Thematic content analysis.Results
Four themes were generated which included people with Mental illness having normal sexual needs, mental illness effect on sexuality and relationships, practices for safeguarding sexuality of people with mental illness and the barriers encountered in the provision of sexual and reproductive health services at a mental hospital.Conclusion
People with mental illness experience a multitude of sexual and reproductive health challenges that need public health interventions. However, the integration of sexual and reproductive health services in a mental hospital are not yet successful making people with mental illness to remain with unaddressed health challenges. Policies should therefore be developed and implemented to ensure successful integration of sexual and reproductive health at all mental health service care provision points.
Nigerian stakeholders' perceptions of a pilot tier accreditation system for Patent and Proprietary Medicine Vendors to expand access to family planning services.
Strengthening leadership and management is important for building an effective and efficient health system. This paper presents the findings from a L&M capacity building initiative which was implemented as part of a larger study aimed at improving maternal and newborn outcomes within primary health facilities in the Morogoro, Tanzania.Methods
The initiative, involving 30 stakeholders from 20 primary health facilities, 4 council health management teams and the regional health management team in the Morogoro region, provided leadership and managerial training through two 5-day in-person workshops, onsite mentoring, and e-learning modules. The initiative was evaluated using a pre-post design. Quantitative instruments included the ‘Big Results Now’ star-rating assessments and a team-developed survey for health providers/managers. The ‘Big Results Now’ star-rating assessments, conducted in 2018 (19 facilities) and 2021 (20 facilities), measured overall facility leadership and management capability, with comparisons of star-ratings from the two time-points providing indication of improvement. The survey was used to measure 3 key leadership indicators - team climate, role clarity/conflict and job satisfaction. The survey was completed by 97 respondents at baseline and 100 at follow up. Paired t-tests were used to examine mean score differences for each indicator. Triangulated findings from focus groups with 99 health providers and health management team members provided support and context for quantitative findings.Results
Star-ratings increased in 15 (79%) of 19 facilities, with the number of facilities achieving the target of 3 plus stars increasing from 2 (10%) in 2018 to 10 (50%) in 2021, indicating improved organizational performance. From the survey, team climate, job satisfaction and role clarity improved across the facilities over the 3 project years. Focus group discussions related this improvement to the leadership and managerial capacity-building.Conclusion
Improved leadership and managerial capacity in the participating health facilities and enhanced communication between the health facility, council and regional health management teams created a more supportive workplace environment, leading to enhanced teamwork, job satisfaction, productivity, and improved services for mothers and newborns. Leadership and managerial training at all levels is important for ensuring efficient and effective health service provision.
Just as the COVID-19 pandemic highlighted the inadequacies of our current health systems and rekindled the debate around universal health care, the Lancet Citizens’ Commission on Reimagining India’s Health System was launched in late 2020. As a part of the commission, we articulated how technology can enable universal health care. We begin by stating the foundational values—a set of normative statements—that should underpin the use of technology in our health systems. Then, after summarising the paradigm shifts necessary to achieve citizen-centred universal health care, we articulate five ‘technology levers’ to enable those shifts. Finally, we describe the intersections and synergies between technology and the other pillars of health systems, namely, human resources, financing, governance and citizens’ engagement.
Onchocerciasis is a disease caused by infection with Onchocerca volvulus, which is transmitted to humans via the bite of several species of black fly, and is responsible for permanent blindness or vision loss, as well as severe skin disease. Predominantly endemic in parts of Africa and Yemen, preventive chemotherapy with mass drug administration of ivermectin is the primary intervention recommended for the elimination of its transmission.Methods
A dataset of 18,116 geo-referenced prevalence survey datapoints was used to model annual 2000–2018 infection prevalence in Africa and Yemen. Using Bayesian model-based geostatistics, we generated spatially continuous estimates of all-age 2000–2018 onchocerciasis infection prevalence at the 5 × 5-km resolution as well as aggregations to the national level, along with corresponding estimates of the uncertainty in these predictions.Results
As of 2018, the prevalence of onchocerciasis infection continues to be concentrated across central and western Africa, with the highest mean estimates at the national level in Ghana (12.2%, 95% uncertainty interval [UI] 5.0–22.7). Mean estimates exceed 5% infection prevalence at the national level for Cameroon, Central African Republic, Democratic Republic of the Congo (DRC), Guinea-Bissau, Sierra Leone, and South Sudan.Conclusions
Our analysis suggests that onchocerciasis infection has declined over the last two decades throughout western and central Africa. Focal areas of Angola, Cameroon, the Democratic Republic of the Congo, Ethiopia, Ghana, Guinea, Mali, Nigeria, South Sudan, and Uganda continue to have mean microfiladermia prevalence estimates exceeding 25%. At and above this level, the continuation or initiation of mass drug administration with ivermectin is supported. If national programs aim to eliminate onchocerciasis infection, additional surveillance or supervision of areas of predicted high prevalence would be warranted to ensure sufficiently high coverage of program interventions.
Globally, nearly 295,000 women die every year during and following pregnancy and childbirth. Emergency obstetric and newborn care (EmONC) can avert 75% of maternal mortality if all mothers get quality healthcare. Improving maternal health needs identification and addressing of barriers that limit access to quality maternal health services. Hence, this study aimed to assess the quality of EmONC service and its predictors in Wolaita Zone, southern Ethiopia.Methodology
A facility-based cross-sectional study was conducted in 14 health facilities. A facility audit was conducted on 14 health facilities, and 423 women were randomly selected to participate in observation of care and exit interview. The Open Data Kit (ODK) platform and Stata version 17 were used for data entry and analysis, respectively. Frequencies and summary statistics were used to describe the study population. Simple and multiple linear regressions were done to identify candidate and predictor variables of service quality. Coefficients with 95% confidence intervals were used to declare the significance and strength of association. Input, process, and output quality indices were created by calculating the means of standard items available or actions performed by each category and were used to describe the quality of EmONC.Result
The mean input, process, and output EmONC services qualities were 74.2, 69.4, and 79.6%, respectively. Of the study participants, 59.2% received below 75% of the standard clinical actions (observed quality) of EmONC services. Women’s educational status (B = 5.35, 95% C.I: 0.56, 10.14), and (B = 8.38, 95% C.I: 2.92, 13.85), age (B = 3.86, 95% C.I: 0.39, 7.33), duration of stay at the facility (B = 3.58, 95% C.I: 2.66, 4.9), number of patients in the delivery room (B = − 4.14, 95% C.I: − 6.14, − 2.13), and care provider’s experience (B = 1.26, 95% C.I: 0.83, 1.69) were independent predictors of observed service quality.Conclusion
The EmONC services quality was suboptimal in Wolaita Zone. Every three-in-five women received less than three-fourths of the standard clinical actions. The health system, care providers, and other stakeholders should emphasize improving the quality of care by availing medical infrastructure, adhering to standard procedures, enhancing human resources for health, and providing standard care regardless of women’s characteristics.
Comparison of learning outcomes of interprofessional education simulation with traditional single-profession education simulation: a mixed-methods study.
Provision of injectable contraceptives by community health workers in sub-Saharan Africa: a systematic review of safety, acceptability and effectiveness
Injectable contraceptives are the most popular method of contraception in sub-Saharan Africa (SSA), but their availability in clinical settings has been severely limited, despite the scarcity of health care providers and limited access to health facilities. WHO and USAID have endorsed the community-based distribution of injectable contraceptives as a promising option for improving access to family planning services and expanding the method mix for women who want to limit the number of births. Studies have shown that community health workers (CHWs) can provide women with injectable contraceptives that meet acceptable quality standards. The goal of this study is to identify, evaluate and synthesize evidence supporting the use of community-based administration of injectable contraceptives in SSA.Methods
This review's guidance was based on a previously developed protocol. Nine international electronic databases and the websites of organizations known to support community-based reproductive health initiatives in SSA were searched systemically. Experts in this area were also contacted for the identification of unpublished literature and ongoing studies. The reference lists of eligible studies were reviewed. The Effective Public Practice Project tool was used to assess the quality and risk of bias in eligible studies. Data were extracted and analysed using a custom data extraction form and a narrative synthesis.Results
The search strategy identified a total of 1358 studies with 12 studies meeting the inclusion criteria. One unpublished study was provided by an expert making a total of 13 studies. The results showed that irrespective of the study designs, well-trained CHWs can competently administer injectable contraceptives safely and community-based delivery of injectable contraceptives is acceptable in SSA. Also, the use of community health workers in the provision of depot-medroxyprogesterone acetate expanded access to inhabitants of hard-to-reach areas and led to an overall uptake of injectable contraceptives as well as family planning. Studies that compared CHWs to clinic-based providers revealed equivalent or higher levels of performance in favour of CHWs.Conclusions
The CHWs can competently provide injectable contraceptives within SSA communities if appropriately trained and supervised. Hence, SSA policymakers should give this initiative due consideration as a way of improving access to family planning services.
Women make up a significant proportion of workforce in healthcare. However, they remain underrepresented in leadership positions relating to healthcare for a multitude of reasons: balancing personal and work duties, favoritism toward men, lack of support from colleagues and mentors, as well as other factors. This study aims to recognize the contribution made by women in the Bahraini healthcare sector by determining the gender distribution in Bahrain’s medical schools, government hospitals, Ministry of Health, and National Health Regulatory Authority.Methods
Data were collected from the Bahraini Ministry of Health, National Health Regulatory Authority, Salmaniya Medical Complex, King Hamad University Hospital, Bahrain Defence Force Royal Medical Services, the College of Medicine and Medical Sciences in the Arabian Gulf University, and the Royal College of Surgeons in Ireland-Bahrain. Only physicians who held a Bachelor of Medicine and Surgery and a valid license to practice from NHRA were eligible to participate. Descriptive statistics were used to derive the frequencies and percentages of physicians with the following leadership positions: (1) top administrative positions (e.g., Chief executive officer); (2) heads of departments; (3) heads of committees; and (4) academic positions (e.g., Professor). Data were also collected from the two medical schools in Bahrain to see the trend in female enrollment into medical schools since 2004.Results
The results of the study indicated that leadership positions were mostly held by males in Bahrain (59.4% vs. 40.6%). However, Bahraini males and females equally dominated academic positions. Male physicians also dominated surgical specialties; however, female Bahraini physicians slightly surpassed male Bahraini physicians at the specialist and consultant levels (female to male: 11.9% vs. 10.4% and 33.2% vs. 30.4%, respectively). Furthermore, more females were reported to have general licenses. A trend analysis since 2004 showed that female medical students’ representation was higher than males over the years.Conclusions
This study highlights the increasing trend of women’s participation and contribution to medicine in Bahrain. The data indicated continued growth in the number of female medical students and physicians. As such, it is likely that females will have a bigger impact on healthcare in the future with potential to hold more leadership positions in Bahrain.
Factors shaping good and poor nurse-client relationships in maternal and child care: a qualitative study in rural Tanzania
Evidence indicates that poor nurse-client relationships within maternal and child health (MCH) continues to impact trust in formal healthcare systems, service uptake, continuity with care and MCH outcomes. This necessitates contextualized innovative solutions that places both nurses and clients at the forefront as agents of change in optimizing intervention designs and implementation. This study explored nurses and clients’ perspectives on the factors shaping nurse-client relationships in MCH care to generate evidence to guide subsequent steps of human centered design (HCD) that involve designing effective strategies for improving therapeutic relationships in Shinyanga, Tanzania.Methods
Qualitative descriptive design was employed. About 9 Focus Group Discussions (FGDs) and 12 Key Informant Interviews (KIIs) with purposefully selected nurses and midwives, women attending MCH services and administrators were conducted using semi-structured interview guides in Swahili language. Data were transcribed and translated simultaneously, managed using Nvivo Software and analyzed thematically.Results
Factors shaping nurse-client relationships were heuristically categorized into nurse, client and health system factors. Nurse contributors of poor relationship ranged from poor reception and hospitality, not expressing care and concern, poor communication and negative attitudes, poor quality of services, job dissatisfaction and unstable mental health. Client contributors of poor relationship include being ‘much know’, late attendance, non-adherence to procedures and instructions, negative attitudes, poor communication, inadequate education and awareness, poverty, dissatisfaction with care, faith in traditional healers and unstable mental health. Health system contributors were inadequate resources, poor management practices, inadequate policy implementation and absence of an independent department or agency for gathering and management of complaints. Suggestions for improving nurse-client relationship included awards and recognition of good nurses, improving complaints mechanisms, continued professional development, peer to peer learning and mentorship, education and sensitization to clients, improving service quality and working conditions, improving renumeration and incentives, strengthening nursing school’s student screening and nursing curriculum and improving mental health for both nurses and clients.Conclusions
The factors shaping poor nurse- client relationships appear to extend beyond nurses to both clients and healthcare facilities and system. Implementation of effective interventions for addressing identified factors considering feasibility and acceptance to both nurses and clients using novel strategies such as HCD could pave the way for employing good nurse-client relationships as a tool for improving performance indicators and health outcomes within MCH care.